Crisis Intervention: A Social Interaction Approach (2) - Audio Tidbits Podcast

Audio Tidbits Podcast

To the inexperienced observer, “crisis” and “the individual in crisis” represent nearly equivalent notions. We say that an individual is “suicidal.” Why? Because he is depressed. We say that an individual is nervous and shaking. Why? Because he is upset. When we take the next step and ask why the individual is depressed or upset, the assumption is that the answer will point to there being something wrong with the individual or with his situation. “You are just being silly.”… “If I were you, I would get out of that situation and not put up with it anymore.”… “If you would just straighten up and deal with it, things would be better.”… “You can’t blame yourself. It’s not your fault. If they didn’t act the way they do, things would be okay.” By the inexperienced observer, then, the ‘crisis’ is interpreted to be something that is either in the individual or in the situation.

As we examine the conflict state in this chapter and focus more specifically on the crisis state in Chapter 3, we will find that the “crisis” is neither within the individual nor within the situation. The crisis lies in how you are or are not getting along within your situation.

Frequently there is conflict between the individual and his world. This situational conflict is an everyday thing. Life is full of its hassles, difficulties, and annoyances. Sometimes, though, the conflict becomes intensified to such an extent that we can accurately think of it as “a crisis state.” Understanding the crisis state and helping the people who are caught up in it is our objective. First, however, we want to carefully examine and come to understand the conflict state from which crises develop. Figure 1 illustrates conflict in terms of the individual, the situation, and the interaction between the two. A careful look at each of these three perspectives is, then, where we will start to develop an understanding of and a feeling for the social interaction approach to crisis intervention. …
THE INDIVIDUAL

Basic to an understanding of the individual in relationship to crisis is the recognition that physical development and physical health are important to everyone at every stage of the developmental process. From birth to about the age of three, children are primarily concerned with physical development. They learn how to sit, walk, talk, use the bathroom, feed themselves, manipulate objects, run, climb, and do all the things they will need to do as they grow and mature. For people of all ages, physical skills, abilities, capacities, needs, and so on, are very important to their sense of who they are and to their ability to cope with their life situation. We can see, then, that whenever an individual is experiencing some physical difficulty he also will have problems in coping with his responsibilities and opportunities. This difficulty in coping may at times be more than the individual can handle. For example, children with serious physical difficulties may become overwhelmed with feelings of inadequacy and helplessness when they are unable to participate in normal activities, do the kinds of things other children do, be accepted by other children as equals, and so on. Adults may suddenly find themselves in a position where they are unable to work, unable to drive, unable to carry out their day-to-day responsibilities, unable to cope with simple routines like getting to the store, and generally feeling inadequate and useless. Elderly people frequently become depressed and overwhelmed by their recent inability to hear, see, walk, and so on. Throughout the life cycle, physical difficulties and health problems represent a serious liability and frequently contribute to social and emotional crises.

Similarly, emotional development is an important dimension. An individual’s emotional makeup receives its primary developmental structure during the preschool years. That is when children learn to love and hate, deal with feelings of anger and fear, express affection and excitement, and generally develop as feeling/emotional persons. Young children first discover their feelings and then experiment with them. Can I get people to do things by using my temper or by pouting? How can I cope with things and situations that scare me? What does it mean to love and be loved? This discovery and experimentation continues throughout the life cycle. Gradually, children learn to control and cope with their feelings and thus become able to prevent their feelings from taking over their behavior or getting in the way of their dealing with the world. For everyone, however, situations and circumstances do occur which cause them to react in emotional and uncontrolled ways. In healthy individuals, this does not happen too often, and usually, it does not interfere with their over-all functioning. For all of us, though, our feelings and emotions sometimes become so overwhelming that they interfere with our thinking about and coping with our life situations. Especially when those overwhelming feelings include fear and anger, we are in a crisis. We find ourselves temporarily unable to deal with, understand, or otherwise cope with, this mix of emotions and feelings, and we are unable to respond rationally. It is, then, our ability to cope with and work through these feelings that enables us to resolve crises in our lives. Further, it is our ability to help others cope with and work through such intense feelings in their lives that represents the focal task of crisis intervention.

Just as emotional crises develop in the lives of others, they can and will develop in our own lives. If it can happen to anyone, it can happen to you or me. If you seriously doubt that you could ever find yourself in an emotional crisis and in need of help, perhaps you should not become involved in crisis intervention. “There but for the grace of God go I” is wisdom especially applicable to crisis.

Children develop socially as well as physically and emotionally. This is the special focus of the elementary school years. Children first learn to entertain themselves and play with their toys and other objects in an individualized way. Only gradually do they learn to be involved in mutual activities with other children. In the early years, two children may be involved in the same activity, playing the same game, acting out the same fantasy, but they’re doing it as individuals. They are both doing the same thing but are not really interacting with each other. As mothers of young children can confirm, the most frequent form of interaction when two young children are playing is fighting and arguing. The complaint is usually that one child interfered with the other child’s toys or activities. Over time, children gradually become involved in activities in which they interact with each other. They participate in group games, carry on endless conversations with each other, play “doctor” and baseball, and begin to develop meaningful interpersonal relationships with other children in their age group. As they continue to mature and develop, their social adjustment comes to include husbands or wives, good friends, acquaintances, relationships with co-workers, and so on.

By the time a child reaches junior high school, and throughout the rest of his life, his social environment becomes increasingly complex and contains more and more possibilities for problems. These social relationships, patterns of interaction, and the over-all social environment continually present situations and conditions with which anyone may have difficulty coping. Usually, people are able to work out their interpersonal differences, negotiate their social world, and resolve problems in relationships. Occasionally, however, these problems become so involved or so bad that people are unable to cope with them and unable to work them out. If the relationships aren’t very important to the individual, he may simply avoid interacting with those people with whom he has difficulty. If the problem happens to be with an employer or employee, however, or with a husband or wife, a parent or child, a very good friend or even someone with whom he doesn’t want to stop interacting, the situation is serious. When confronted with that kind of problem, most people will make a serious attempt to straighten things out. If they are unsuccessful, they will occasionally become quite upset, afraid, angry, and emotionally distraught. These emotions then interfere with their ability to work out the relationship. As the relationship gets worse, the individual becomes more upset. As a result, the relationship deteriorates even further, with the individual becoming even more upset. And so the vicious circle goes round and round. When this happens, the individual is in an extremely serious social crisis.

Sexual development and sexual situations hold a similar potential for crisis. These sexual crises sometimes develop when parents become alarmed and overreact to the interest of young children in each other’s bodies. Sexual crises develop between adolescents, in marital relationships, in homosexual relationships, between adults involved in extramarital activities, and in other types of adult sexual relationships. Similarly, people of all ages can become involved in spiritual and moral crises. They may have difficulty coping with their lack of faith in a supreme being or they may suddenly come to question their faith in a supreme being, they may become confused and disenchanted with the religious and spiritual beliefs they have held, and so on. People become involved in situations that cause them to question their moral values, experience severe feelings of guilt and apprehension, or become indignant and angry in reaction to what they regard as the moral indiscretions of others. In times of spiritual and moral crisis, the great temptation is to pass judgment, give advice, or dismiss the person’s feelings and confusion as silly and inconsequential. It is important to realize that moral and spiritual crises are at least as intense as emotional and social crises. They always deserve our concerned and caring attention.

As we consider the individual, it is clear that his physical, emotional, sexual, moral, and spiritual growth and development play an important part in his over-all adjustment and in his ability to cope with life situations. Singly and in combination, these areas of development and adjustment hold high potential for crisis, and in times of crisis, the inability of the individual to work out the difficulty causes intense and varied emotional reactions. It is, then, our ability to help him cope with and work through these feelings, together with our ability to work with the rational, reasoning, planning dimension of the individual, that enables him gradually to understand and cope with his crisis.

The individual in crisis is a whole person with feelings, emotions, thoughts, ideas, abilities, limitations, and personality. Like all of us, he loves and hates, is sad and excited, wants and fears, feels happy and hurt, and experiences a full range of feelings, emotions, joys, sorrows, and humanness. Also, whether the individual is six or sixty, he has his rational, objective, intelligent, analyzing, understanding, reasoning dimension. When we meet the individual in a crisis situation, however, his feeling, emotional, impulsive dimension will likely be most visible.

The individual also has a third dimension. It has alternatively been seen as his conscience, superego, or “parent.” This dimension is an integral part of the individual’s personality and consist of rules, prohibitions, norms, values standards, prejudices, “should” and “shouldn’t,” and words like always, never, absolutely, must, have to, and so on. This dimension serves the individual as an internalized “parent.” It punishes him when he does not do well, when he does wrong, or when he behaves in a way unacceptable to his conscience or the internalized “parent.” Also, it praises him or makes him feel good when he behaves in an acceptable, moral, honorable way. Further, it protects him and makes him feel afraid or anxious when he is confronted with situations or circumstances in which there is or may be some risk to himself.

When we see the individual in a crisis situation, we will generally first notice the intensity of his feeling, emotional dimension. As suggested, one of our central goals is gradually to enhance the functioning of the rational, planning, thinking dimension. As we work toward this enhancement and crisis reduction, however, his “parent’ dimension must be carefully looked at and its effects considered. Is the individual usually fearful? Or, is he unusually guilt-ridden? Is he withdrawn and apparently punishing himself? Basically, we want to know the punishing, praising, and protecting effects the individual’s “parent” is having on his feeling, emotional dimension. If we think of the individual as a whole, three-dimensional person, understanding that these three dimensions are interacting and interrelated, and try to understand and sort them out as we work with him, our effectiveness will increase.

If we can maintain our perspective, recalling the three major dimensions of the individual and understanding his developmental needs, problems, and vulnerabilities, we will be in a good position to help him in a meaningful way. …
THE TOTAL SITUATION

Next comes the individual’s total situation. This includes everything external to him that affects him or is affected by him. It includes friends, pets, his job, house and car, the weather, bill collectors, and so on, until we have listed everything and everyone in his total situation. This is his “now.” It is his present, including people, relationships, things, circumstances, events, and so on. The individual’s total situation also includes “then” and “when.” “Then” is the individual’s past, and it shapes and affects the way things are now in his present. It is important to see that “when” is not the future; rather it is the way the individual feels or thinks the future will be when certain things happen or do not happen, when he does or does not accomplish some goal, if circumstances change or do not change, and so on. It is not how things actually will be, but rather, it is how the individual thinks things probably will be.

Of course, “then” and “now” are also, for the individual, a blend of actual events and circumstances, on the one hand, and his perception of those events and circumstances, on the other. It is important to understand, however, that “when” is an anticipated set of events and circumstances combined with the individual’s feelings and anxieties about those events and circumstances. It is this anticipatory anxiety that gives “when” it’s special significance in crisis situations.

In such situations it is common to find that the individual’s perception of future events, within the context of his total situation, has a significant influence on his present feelings, emotions, attitudes, ideas, judgments, and so on.

Figure 2 emphasizes the point that understanding the individual’s total situation “now” necessarily involves not only understanding his “then” but also includes understanding his “when.” Effective intervention in crisis situations requires that we bring together our understanding of the whole person with an understanding of his total situation. This understanding will probably be somewhat sketchy, but our goal is to develop a mental picture of the individual and his total situation. Such a picture, although lacking in full detail, will include an outline of important family, business, and friendship relationships; important social, economic, and environmental factors; and a sensitivity for strong emotions, feelings, beliefs, and attitudes. It represents, for us, a real “feel” for the individual and his total situation. When we are dealing with crises, time does not permit the development of inclusive or exhaustive detail. We are instead pressed for a general understanding of the individual and what is happening with him now.

Our understanding of the individual and his present situation will probably begin with an understanding of his present emotional state. Is he nervous or calm, angry or sad, upset or relatively peaceful? We will then try to develop some understanding of his social environment. If we are talking with a child, we will want to know how he is getting along with his family, in school, with other children, with his brothers and sisters. If we are talking with a teenager, we will want to combine these areas with some questions about boy-girl relationships. If we are talking with an adult, we will want to include questions about family, employment, and other adult situations. We may want to inquire about his physical health and see if he has any special difficulties in dealing with day-to-day situations. We may want to be alert to any suggestion of sexual, moral, or spiritual difficulty. There will be instances in which we will want to inquire about how adequately the individual’s needs for food, clothing, and shelter are being met. If the person has called us on the hot line, we may want to know something about where he is, his living circumstances, and so on. As this understanding of his present situation develops, we may want to ask what kind of events and circumstances in his past life are especially affecting his present situation. In addition, we will want to know a little about how he thinks the future will be, what the outcome of his problem might be, how things will be when the crisis is over. In general we want to understand his “then,” “when,” and “now,” his total situation, and him as an individual. It is important to stress that this picture of the crisis may well be somewhat sketchy and may not necessarily include the same details in each situation. Here, it is enough to think about the kinds of things that may be important in and contribute to crisis situations. …
THE INTERACTION

We have focused on the individual and on his total situation; next comes the interaction between the two. He is a whole person, and his total situation is everything affecting or affected by him. The affecting or being affected by is what is meant by interaction. As seen in Figure 1, the interaction is between the individual and his total situation. Conflict, then, from this social interaction perspective, is in that interaction. The difficulty or problem is with some conflict or tension in the interaction between the individual and his situation. This is the first focal point in understanding crisis intervention. The type of conflict considered here is neither in the individual nor in his total situation. It is, rather, in the interaction between the two. As we define crisis later, this interactional understanding of conflict is essential to understanding the crisis intervention process.

Ann, age fourteen, seems somewhat drowsy and is not speaking very clearly. “I don’t think it will help any. My friend told me to come talk with you. That school—I’m not going back. I’m not going to hassle it anymore. [You ask: What happened?] He did it again. That damn Mr. Z thinks he knows everything—he is the only one that knows anything. Kids are nothing. He thinks he’s a real big man hassling kids. [You ask: What happened?] I don’t know—the same ol’ thing. He got on me. He said I was using dope. He said he was going to turn me in to the ‘pigs.’ He called my mom; that’s the end of that. [You ask: What did your mom say?] I don’t care what she says; she’ll probably tell Dad. [You ask: What will he say?] He’ll have a fit; that’ll really be something. There’s no way I’m going home. You can’t make me go home. [You ask: Was I trying to make you go home?] No. But I’m not going home. I’m not going back to that place. [You say: That place?] I can’t stand it anymore. There’s too much hassle. [You say: What’s the problem?] Dad’s been laid off, and he’s drunk all the time. He’ll kill me if he finds out about this. I’m going over to Jane’s house and drop some acid. I’m going to get so high and so out of my mind. [You ask: Will that make things better?] It won’t hurt anything, that’s for sure. We do it all the time. It’s fun.”

At first glance, it may be difficult to see that Ann’s conflict lies within the interaction between herself and the situation. She has difficulty adjusting satisfactorily at school, is using drugs, and seems to have a negative attitude. It would be tempting to conclude that she has deep emotional problems that need intensive and long-term psychiatric treatment. In terms of her situation, it is clear that Mr. Z has difficulty in dealing with Ann and has threatened to turn her over to the police. In addition, her home life is not good. Her father is out of work and is apparently drinking excessively. It would be tempting to say that the real problem is with Ann’s home situation and with the way Mr. Z is coping with Ann’s drug involvement. In terms of Ann’s present crisis, though, the conflict is in the interaction between Ann and her situation. Her interaction with Mr. Z and at school has deteriorated to the point where Ann has run away. Her relationship with her family is so bad that she is either unwilling or perhaps afraid to return home. She has chosen to go to a friend’s house and to use more drugs, at this point, the only way she is able to cope. The school and Mr. Z are getting along fine without Ann. Her family is having its own continuing difficulty regardless of her. Right now, Ann is talking with you and is all right. Her family and school are not dealing with her and do not have her problem. The problem or conflict comes up only when Ann interacts with her family or school. As you look at this and other examples of crisis, it is important to see that the immediate conflict, the kind of conflict being discussed here, is not “in the individual” or “in the situation.” It is, rather, within the interaction between the individual and the situation.

An important point has been introduced here. Part of your objective in crisis intervention will be to reduce the immediate conflict, which means here, in part, that you do not want to increase Ann’s tensions by becoming angry with her, moralizing about her use of drugs, telling her that she should show more respect to Mr. Z, or insisting that she return home. The result undoubtedly would be increased conflict in the relationship between Ann and you. Anything you could do to reduce the conflict in her interaction with her situation would be offset by the fact that your behavior would increase the conflict between her and her immediate situation, that is, between you and her. …
CONFLICT

What is conflict? We know where it is. It is located in the interaction between the individual and his total situation. Essentially, conflict is whatever people think it is. If the individual or someone else in his total situation thinks or feels that things are not right or are not as they should be, there is conflict. The point warrants further discussion. If the individual or someone in his total situation (husband, wife, son, daughter, doctor, minister, teacher, friend, policeman, etc.) thinks or feels that the effect on the individual or on his behavior is not as it ought to be or that something or someone within his total situation is having a negative or an undesirable effect on him, then there is conflict. Less specifically, if the individual or someone in his total situation thinks or feels that the interaction between the individual and his total situation is “messed up” or problematic, there is conflict. In crisis intervention, our orientation is to the individual in crisis. We will start with his understanding of the conflict, knowing that he is usually the best judge of whether or not there is a conflict. If he tells us that a conflict exists within his interaction, we will accept the existence of the conflict as a fact. Alternatively, if someone else in his total situation tells us that there is a serious conflict or crisis, we will initially accept that report as true and follow through with our efforts to understand and resolve the conflict. This initial intervention may lead us to the conclusion that there really is no crisis and that someone is overreacting, making a big deal over nothing. Usually, though, family, friends, employers, neighbors, police, and others are fairly accurate when they tell us someone is really hurting or is in a crisis. Our task is to find out for ourselves by evaluating the individual, his total situation, and the interaction. If there is a crisis, we can help the individual resolve it. If no crisis exists, our interest and intervention will help the alarmed family, friend, employer, neighbor, police, or others to calm down, better understand the situation, and not worry so much.

Occasionally, especially if we have a professional relationship with the individual, we will be the one who recognizes and points out the existence of the conflict. But regardless of who recognizes the conflict and initiates intervention, we will continue our intervention process until the conflict is, itself, resolved or until our judgment and experience let us know that there really is no crisis.

Mr. E calls on the hot line. You are a young woman and initially feel that you have received a crank call. The caller has difficulty talking, slurs his words, and appears to be drunk. “What’s you name, honey? I’ll bet you’d be a lot of fun. [You give him your telephone name and ask him: Can we help you?] I’m here having a few drinks. Do you want to come down and have a little drink with me? [You say: We just talk to people on the telephone. Can we help you?] Oh, come on now, I’ll bet you’d like a little drink. I won’t get fresh; we’ll just have a little drink and talk about things. We’ll just talk and keep each other company. That way we won’t have to be alone. I bet you don’t like to be alone either, do you? [You say: It’s pretty rough sometimes when we’re alone and don’t have anyone to talk to.] I don’t want you to get to thinking that I don’t have any friends or anything. I have lots of friends. They are all busy, and I don’t know where they are tonight. I usually have lots of friends and lots of people to talk to, but tonight I’m just here by myself having a little drink. I’m just having a little drink. You probably think I’m drunk, but I’m just having a little drink. You have a really sexy voice—has anyone ever told you your voice is sexy? [You say: Thank you. You sound kind of lonely.] It’s been lonely since she died. My wife, she died a while back. [You say: That’s sad. How long have you been alone?] It’s been three weeks now. I just can’t get used to it. I’ve started drinking a little too much, and nothing seems to matter much one way or the other anymore. [The caller is noticeably sobbing. You say: Do you have any kids or other family?] Five, but they are all grown now. They’ve moved away and have their own lives. I’m by myself and don’t know what to do. I just need someone to talk to. I’m sorry to bother you. [You say: You’re not bothering me. I want to talk if you want to talk for a while.] It’s good to have someone to talk to; I get so lonely. I don’t know what to say. I’m sorry for getting fresh with you. I just can’t stand the loneliness. I had to talk to someone.”

The incident with Mr. E shows that we should always assume that the individual does have a serious problem. Had the volunteer followed her initial reaction, she would have dismissed Mr. E as a crank caller and would have missed an important opportunity to help. The point is that conflict is whatever the individual or someone else says it is. Initially, someone may have difficulty explaining the conflict to us or helping us understand that a conflict really exists. In crisis intervention, we accept any report of the conflict as true and pursue the situation until we have enough information to be absolutely convinced that an important conflict does not exist. Skillful crisis intervention never takes a possible crisis situation lightly and never jumps to the conclusion that the individual is merely a crank. …
CAUSES OF CONFLICT

A further point about the conflict state must now be made. We know that the conflict is located in the interaction between the individual and his total situation, and from our own observations and the report of the individual or someone else, we have an idea about what the conflict is. We also need to know why a conflict exists between this individual and his total situation. At a rather simplistic level, reserving detailed understanding for later sections of this text, the “why” of the conflict is because someone or something is causing it. The conflict is itself within the interaction between the individual and his total situation. However, the cause of the conflict is due either to the individual or to someone or something in his total situation. The point here is that the cause can come from either side of the interaction or can represent some casual mix from both sides.

The Conflict for Ann was in the interaction between her and her family and between her and her school. Mr. E’s conflict is somewhat more subtle. In his past, or “then,” he had a significant relationship with his wife. His wife’s death resulted in the loss of this extremely important relationship. Mr. E therefore became very lonely and developed feelings of emptiness and disconnectedness from his total situation. The conflict, then, has something to do with his inability to cope with the loss of his wife and the absence of other significant relationships in his life. At least when he called the hot line, his conflict had a lot to do with his being by himself and not having anyone to talk with. For both Ann and Mr. E the conflict is in the interaction between them and their total situations. The cause or causes of their conflict, however, are within them and within their total situation. Ann’s conflict is, in part, caused by her drug use and her negative attitude. In addition, her conflict stems from her family situation and from the way Mr. Z dealt with her drug use. The cause of her conflict is clearly a mix of factors both within her and within her total situation. For Mr. E, the most obvious cause of his conflict is the death of his wife. That event occurred in his “then,” in his past, and is clearly located in his total situation. In addition, the problem of not having anyone to talk with is also located in his total situation. Still, we may want to consider the possibility that Mr. E has a drinking problem and that his tendency to withdraw is part of his personality. If this is true, then part of the cause of Mr. E’s conflict comes from within him and his way of coping with the situation. His immediate conflict, however, seems to be primarily caused by his wife’s death. Even though his conflict may be caused by a mix of factors both within him and within his situation, the conflict seems to have resulted primarily from events in his life situation.

In these and other crisis situations, we will see that the cause of the conflict comes from the individual, from the situation, or from some combination of factors within the individual and the situation. A simple point can be introduced here and expanded later. As we work toward reducing conflict, our intervention will need to lead to some change either in the individual or in the situation. Conflict is in the interaction. Change comes through the individual or through modification of the situation. …
IN SUMMARY

Conflict lies at the interface between the individual and his total situation, is objectively or subjectively perceived by the individual or someone in his total situation, and is causally a function of the individual and/or his situation.

Experience suggests that non-mental health professionals and volunteers tend to perceive the individual in crisis as sick and are thus oriented to a medical model, that is, have a tendency to think in terms of diagnosis and treatment of the problem as if it were something totally within the individual himself. Reorientation to the social interaction model requires careful attention to and emphasis on locating and dealing with the problem or conflict as a function of the interaction between the individual and his situation. This reorientation also encourages moving away from a tendency to place blame and to identify individual pathology, and toward intervention based on an interactional understanding, thereby working with the strengths and capacities within both individuals and situations.