Crisis control

Crisis control

A number of factors determine how emotional, physical and psychological issues are resolved following a traumatic event

By Patti Carmalt-Vener 04/25/2013

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Dear Patti,
I’ve experienced deaths and illnesses of beloved family members, but the most terrifying and painful situation I’ve ever encountered happened recently. Our 15-year-old daughter, Gracie, and her friend, Jenna, were kidnapped at gunpoint and held captive in an isolated house for several days by a pair of young men in their early 20s. Although they were never raped or sexually abused, their lives were threatened many times and it was an unbelievably horrific and shocking experience for them. Those four days were the longest and most paralyzing of my life, but thank goodness it’s over. Police, medical, psychological and legal support are on board, and I’m confident everything is being taken care of for the girls the best that it can be under the circumstances.   

Our respective families are getting close and everyone is very supportive of the girls, but my husband and I are still worried about Gracie emotionally. The psychotherapist that evaluated Jenna recommended she have counseling right away. The psychotherapist that evaluated Gracie has recommended crisis intervention counseling for six weeks prior to entering counseling. Gracie’s doctor agrees that our daughter is “in crisis,” but we don’t understand what this means. Could you explain this as well as tell us what the difference is between crisis intervention and other counseling?

— Bianca

Dear Bianca,
I’m so very sorry that all of you — but especially Gracie and Jenna — have gone through such a terrible, heart-wrenching experience. Fortunately, there are usually fewer long-term effects on a one-time event if it is treated right away and when the victims of such incidents are supported rather than blamed in any possible way for its occurrence. The severity of the event, the individual’s personal adaptive responses and the availability of social resources are all factors that determine how quickly the emotional, physical and psychological issues will be resolved.

Crises are acute experiences or situations that catch people off guard and throw them into a state of psychologically paralyzing chaos. The sudden loss of ability and lack of resources to cope with a situation that seems insurmountable can cause grave distress pertaining to mood, behavior and thinking.

A crisis has four parts: (1) an unpredictable precipitating event, situation or obstacle, (2) a stressful perception of the event that is beyond the coping abilities of the individual, (3) a temporary period of emotional disequilibrium stemming from disorganization of the normal psychological state, and (4) a level of functioning in social, occupational, emotional and relationship areas that is now lower then before the event occurred. Every person is different, but there are certain symptoms such as shock, impaired judgment and a feeling of powerlessness that Gracie is probably experiencing if in crisis.

The goal of crisis intervention therapy is to resolve an immediate crisis and restore the patient to a pre-crisis level of functioning by reducing symptoms, providing support and developing appropriate therapy.

There are two main stages in crisis intervention therapy; specifically, assessment and intervention. During the assessment phase, the therapist will explore the specifics of the precipitating event that happened to your daughter, the resulting crisis, whether she’s in danger to herself or others, whether she needs to be hospitalized, compare what her pre-crisis functioning was versus her current functioning and identify her personal inner resources and support systems.

In the intervention phase of therapy, the therapist will listen to and support Gracie with empathy and concern. Various crisis communication techniques will be used such as reflection, which will clarify the issues and entail active involvement between Gracie and the therapist. This will allow the therapist to understand what happened from your daughter’s perspective.

The therapist will probably also use a lot of direct questioning, especially if Gracie is withdrawn, emotionally numb or if her thinking is temporarily impaired by the crisis.

Nonverbal communication will be employed as well in which the therapist conveys interest and concern for Gracie by means of attentive eye contact and body posture.

Most importantly, the therapist will help Gracie gain access to her feelings, gain an intellectual understanding of the crisis event, regain self-esteem and confidence, learn 
coping mechanisms, increase self-care and embrace hopefulness and a realistic plan for the future. 

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her Web site, patticarmalt-vener.com.

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