TECHNIQUES

OF

sivagiri p
M.Sc Nursing II yr
INTRODUCTION-

• Stressful situations are a part of everyday life. Any stressful situation

can precipitate a crisis. Crises result in a disequilibrium from which
many individuals require assistance to recover.
• Crisis intervention requires problem-solving skills that are often
diminished by the level of anxiety accompanying disequilibrium.
Assistance with problem solving during the crisis period preserves
self-esteem and promotes growth with resolution.
 DEFINITION
• According to Taylor 1982 “Crisis is a state of disequilibrium resulting
from the interaction of an event with the individual’s or family’s
coping mechanisms , which are inadequate to meet the demands of
the situation combined with the individual’s or family’s perception of
the meaning of the event.

• A sudden event in one’s life that disturbs homeostasis, during which

usual coping mechanisms cannot resolve the problem.
- Lagerquist.
Cont…
• It occurs when individuals are confronted with problems that can’t be
solved. These irresolvable issues result in an increase in tension, signs
of anxiety, a subsequent state of emotional unrest, and an in ability to
function for extended periods.
-CAPLAN 1964

• Event or situation perceived as intolerably difficult that exceed an

individual’s available resources and coping mechanisms.
-JAMES & GILILAND (2005)
 TYPES OF CRISIS
CLASS 1: Dispositional Crises
CLASS 2: Crises of anticipated life transitions
CLASS 3: Crises resulting from traumatic stress
CLASS 4: Maturational/Developmental crises
CLASS 5: Crises reflecting psychopathology
CLASS 6: Psychiatric emergencies
CRISIS INTERVENTIONBALANCING FACTORS-

Crisis good
outcome
Crisis
development
CHARACTERISTICS OF A CRISIS

1. Crisis occurs in all individuals at one time or another and is not

necessarily equated with psychopathology.
2. Crises are precipitated by specific identifiable events.
3. Crises are personal by nature. What may be considered a crisis
situation by one individual may not be so for another.
4. Crises are acute, not chronic, and will be resolved in one way or
another within a brief period.
5. A crisis situation contains the potential for psychological growth or
deterioration.
STAGES OF CRISIS
1.HAZARDOUS
EVENT

2.VULNERABL
5.REINTEGRATION
E STATE

3. PRECIPITATING
4. ACTIVE CRISIS
STATE FACTOR
PHASES IN DEVELOPMENT

PHASE-1 PHASE-2

PHASE-3 PHASE-4
three factors
• 1. The individual’s perception of the event.
• 2. The availability of situational supports
• 3. The availability of adequate coping mechanisms.
SIGNS AND SYMPTOMS OF
CRISIS
• The major feeling in crisis situation is anxiety. The individual
experiences a heavy burden of free floating anxiety.
• The anxiety may be manifested through depression, anger and guilt.
The victim will attempt to get rid of the anxiety using various coping
mechanisms, healthy or unhealthy.
• Inability to do daily activities effectively.
• Negligence of responsibilities
• Irrational.
 RESOLUTION OF CRISIS
• Realistic appraisal of precipitating factors
• Availability of support system
• Availability of coping measures over a life time
 TYPES OF RESOLUTION
• Crises tend to be time limited, generally lasting no more than a few
months; the duration depends on the stressor and on the individual’s
perception of and response to the stressor”.
• Crises can become growth opportunities when individuals learn new
methods of coping that can be preserved and used when similar
stressors recur.
• Crisis Intervention refers to the methods used to offer immediate,
short term help to individual who experience an event that produces
emotional, mental, physical and behavioural distress or problems.
• A crisis can refer to any situation in which individual perceives a
sudden loss of his or her ability to use effective problem solving and
coping skills
 AIMS
• To provide a correct cognitive perception of the situation
• To assist the individual in managing the intense and overwhelming
feelings associated with the crisis.
 Goals of crisis Intervention-
• Relieving the client's symptoms;

• Restoring the client to his/her previous level of functioning;

• Identifying the factors that led to the crisis state;

• Identifying and applying remedial measures;

• Helping the client connect current stresses with past life experiences; and

• Helping the client develop adaptive coping strategies that can be used in the
current situation as well as in any future situation
 INDICATIONS
• Geriatric • Severe anxiety and depression
• Adolescent- maturational crisis • Marital conflicts
• People who attempted suicide • Suicidal thought
• Psychosomatic patients • Illicit drug abuse
• Violent behaviour • Traumatic events or traumatic
• Accident victims experiences
• Family crisis • Intra group staff issues
• High risk families.e.g: ill member • Client management issues
recently died
PRINCIPLES OF CRISIS INTERVENTION
REQUISITES FOR THE EFFECTIVE
CRISIS INTERVENTION
• In addition to being nonjudgmental, flexible, objective, empowering,
supportive, following are considered to be essential requisites for
service providers to enable and individual to a journey from a
vulnerable crisis.
• Ability to create trust via confidentially and honesty.
• Ability to listen in an attentive manner
• Provide the individual with the opportunity to communicate by
talking less.
• Being attentive to verbal and non verbal cues.
• Pleasant, interested, intonation of voice.
• Maintaining good eye contact, posture and appropriate social
distance if in a face to face situation.
• Remaining undistracted, open honest, sincere.
• Asking open ended questions.
• Asking permission, never acting on assumptions.
• Checking out sensitive cross-cultural factors.
• LENGTH OF TIME FOR CRISIS INTERVENTION
The length of time for crisis intervention may range from one session
to several weeks, with the average being four weeks.

• PLACE OF INTERVENTION-
It can take place in a range of setting such as hospital emergency room,
counseling centres, mental health clinics school and social service
agencies, community settings, telephonic counseling and crisis
intervention centres.
 TECHNIQUES
OF
CRISIS INTERVENTION
According to Hollis,

DIRECT
SUSTAINMENT
INFLUENCE

PERSON DYNAMIC &

SITUATION FUNDAMENTAL
REFLECTION UNDERSTANDING
 Theories of crisis and crisis intervention

• Grief theory ( Lindemann)

• Systems theory stresses the interrelationships and interdependence
among people and between people and events. The theory refers to an
emotional system, a system of communications, and a system of need
fullfillment and request in which all members within an intergenerational
relationship bring something to bear on each other.

• Adaptational theory depicts a person’s crisis as being sustained through

maladaptive behaviors, negative thoughts, and destructive defense
mechanisms. A person’s crisis will recede when these maladaptive coping
mechanisms are changed to adaptive ones.
• Interpersonal theory describes how enhancing personal self-esteem
and belief in others. When people confer their locus of self-evaluation
on others, they become dependent on others for validation of their
being.

• Applied crisis theory: View each person and each crisis sit. as
different. Brammer characterizes applied crisis theory as
encompassing 3 domains: (1) normal developmental crises; (2)
situational crises; (3) existential crises.
MODELS
THE EQUILIBRIUM MODEL
THE EQUILIBRIUM MODEL
THE COGNITIVE MODEL
THE PSYCHOSOCIAL MODEL
GILLAND’S SIX STEP MODEL
Listening
• defining the problem
• ensuring client safety
• providing support
Action
• examining alternatives
• making plans
• obtaining commitment
 SEVEN-STAGE MODEL OF CRISIS
INTERVENTION
 MODALITIES
OF
CRISIS INTERVENTION
1. MOBILE CRISIS PROGRAMS
2.TELEPHONE CONTACTS 3.GROUP WORKS
4.DISASTER RESPONSE 5.VICTIMS OUTREACH
Crises tend to be time limited, generally lasting no more than a few months; the duration depends on the stressor and on the individual’s perception of and response to the stressor”. Crises can become growth opportunit
The following are several components of crisis prevention that can be
examined.
a) Access needs, and other homes with available staff; how quickly can
the on call team arrive once they are called.
b) Access coordinators, and resource teams
c) Access to community resources – for example, does the community
have health services (e.g. clinics, crisis phone lines, psychiatric unit) and
community emergency services (e.g. police, ambulance, Emergency
room).
Environmental manipulation
• Daily Routines-
• Support Team
Each person has an important role in crisis prevention, which may include:
• Their family members provide information that can help anticipate
situations of concern, and support the individual through planning
• The formal guardian advocates for the least intrusive and restrictive
approaches that are in the best interests of the individual
• The family doctor monitors the side effects of medication (e.g. drowsiness,
agitation, weight gains/loss), and other health conditions (e.g. diabetes,
epilepsy)
• The psychiatrist prescribes medication to address diagnosed
psychiatric disorders in the individual and reduce behaviours of
concern
• The mental health worker teaches the individual coping skills for
stressful situations
• The behaviours consultant designs planned approaches for staff to
support the individual in stressful situations.
• The residential, vocational and school support staff implements
planned approaches, and helps determine the effectiveness of the
other supports to the individual.
• The team should meet regularly to ensure that the information
provided is clear, consistent and current. By doing so, team members
can offer each other suggestions and more immediate assistance.
• Staff Training
• Responding to a Crisis
• What Service Providers do to prevent a crisis
• To respond to a critical incident
• To recover and plan after the crisis
ROLE OF NURSES IN
CRISIS INTERVENTION
TITLE- Crisis Intervention for People With Severe
Mental Illnesses.

• RESULT-. Use of the Client Satisfaction

Questionnaire (CSQ-8) at 20 months’ follow-up
also indicated that patient satisfaction was
significantly higher in the crisis intervention group.
CONCLUSION
• Crisis intervention is an immediate and short-term psychological care
aimed at assisting individuals in a crisis situation in order to restore
equilibrium to their biopsychosocial functioning and to minimize the
potential of long-term psychological trauma.