crisis intervention for 1 mscn

8/7/2019 crisis intervention for 1 mscn

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CRISISCRISIS

INTERVENTIONINTERVENTIONARUN S NATHARUN S NATH

LECTURERLECTURERDEPT.OF MHNDEPT.OF MHN

KPBNIKPBNI


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Crisis TheoryCrisis Theory

StateState ofof CrisisCrisis TheThe organismorganism isis inin aa

temporary,temporary, statestate of of disequilibriumdisequilibrium

,, precipitatedprecipitated byby aa

stressorstressor characterizedcharacterized asas inescapableinescapable.. AnAn intenseintense

situationsituation thatthat overwhelmsoverwhelms ourour usualusual copingcoping

mechanismsmechanisms..

DefinitionDefinition::


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Balancing stressful eventBalancing stressful eventHuman organism

State of equilibrium

State of disequilibrium

Need to restore equilibrium

Stressful eventStressful events

A. Balancing factors presentB. One or more balancing factors absent

Adequate situational supportPLUS

Realistic perception of the event

PLUS

Adequate coping mechanisms

RESULT IN

Resolution of the problem

Equilibrium regained

No Crisis

Distorted perception of the eventAND/OR

No adequate situational support

No Adequate coping mechanismsAND/OR

Problem unresolved

Disequilibrium continues

RESULT IN

Crisis


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PHASES OF CRISISPHASES OF CRISIS

STRESS ANXIETYUSUAL COPING

MECHANISMS

INEFFECTIVE

TRIAL & ERROR

SOLUTIONS

SEVEREANXIETY

PERSONALITY

DISORGANIZATION

(CRISIS)

OR

NEW PROBLEM- SOLVING

SOLUTIONS AND SUPPORT

ANXIETY

PRE-CRISIS LEVEL

OF FUNCTIONING


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What is it?What is it?

AA crisiscrisis occursoccurs whenwhen aa stressfulstressful lifelife eventsevents

overwhelmsoverwhelms anan individuals'individuals' abilityability toto copecope

effectivelyeffectively inin thethe faceface ofof aa perceivedperceived challengechallenge

oror threatthreat..(( AuerbachAuerbach && KilmannKilmann,, 19971997))


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AA psychologicalpsychological disequilibriumdisequilibrium inin aaperson person whowho confrontsconfronts aa hazardoushazardous

circumstancescircumstances thatthat for for himhim

constitutesconstitutes anan importantimportant problemproblemwhichwhich hehe cancan forfor thethe timetime beingbeing

neitherneither escapeescape nornor solvesolve withwith hishis

customarycustomary problemproblem--solvingsolvingresourcesresources.. CaplanCaplan ((19641964))


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AA crisiscrisis maymay bebe thoughtthought ofof asas aa responseresponse conditioncondition

whereinwherein::

1.1. psychologicalpsychological homeostasishomeostasis hashas beenbeen disrupteddisrupted ;;2.2. onesones usualusual copingcoping mechanismsmechanisms havehave failedfailed toto

reestablishreestablish homeostasishomeostasis andand

3.3. thethe distressdistress engenderedengendered by by thethe crisiscrisis hashasyieldedyielded somesome evidenceevidence ofof functionalfunctional

impairmentimpairment..


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Crisis TheoryCrisis TheoryBy Ivor BrowneBy Ivor Browne


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The Nature of CrisisThe Nature of Crisis

You can only go halfway into the darkestYou can only go halfway into the darkestforest, then you are coming out the other sideforest, then you are coming out the other side

Chinese ProverbChinese Proverb Crisis areCrisis are

painful, difficult, and threatening situationspainful, difficult, and threatening situations

unexpected, unpredictable and unwantedunexpected, unpredictable and unwantedexperiencesexperiences

unavoidable events and circumstancesunavoidable events and circumstances emotionally, psychologically andemotionally, psychologically and

physically challengingphysically challenging

opportunities for transformationopportunities for transformation


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Fear is a natural reaction to movingFear is a natural reaction to movingcloser to the truthcloser to the truth Pema ChodronPema Chodron

Fear is a universal experience when facedFear is a universal experience when facedwith crisiswith crisis

Fear provides us with the energy needed toFear provides us with the energy needed to

travel through the crisistravel through the crisis Fear that is faced diminishes; fear that isFear that is faced diminishes; fear that is

avoided strengthensavoided strengthens

All decisions are choices between love andAll decisions are choices between love and

fearfear Openness doesnt come from resisting ourOpenness doesnt come from resisting our

fears, but from getting to know them wellfears, but from getting to know them well --P.P.Chodron (2001)Chodron (2001)


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TransformationTransformation

Adversity leads to diversity; diversity leads toAdversity leads to diversity; diversity leads tochoice; choice leads to freedomchoice; choice leads to freedom

Crisis affords the opportunity to be victim orCrisis affords the opportunity to be victim orvictorvictor

It is no longer possible to be who one was; itIt is no longer possible to be who one was; itis only possible to become who one must beis only possible to become who one must be

-- How can I be myself when I cant do theHow can I be myself when I cant do thethings that maintain my image of myself?things that maintain my image of myself? Rosenbaum, 1998Rosenbaum, 1998


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TypesTypes

MaturationalMaturational developmentaldevelopmental eventsevents rolerole

changeschanges

SituationalSituational lifelife eventsevents upsetupset equilibriumequilibrium


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TYPES OF CRISISTYPES OF CRISIS

Developmental (Maturational) CrisisDevelopmental (Maturational) Crisis-- predictedpredictedtimes of stress in everyones life which occurs intimes of stress in everyones life which occurs inresponse to a transition from one stage toresponse to a transition from one stage toanother in the life cycle.another in the life cycle.

ExampleExample-- Eriksons stages going fromEriksons stages going from

Industry to IdentityIndustry to Identity


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TYPES OF CRISISTYPES OF CRISIS

(Continuation(Continuation))

SituationalSituational CrisisCrisis-- occursoccurs inin responseresponse toto aasuddensudden unexpectedunexpected eventevent inin aa personspersons lifelife..TheThe criticalcritical lifelife eventsevents revolverevolve aroundaroundexperiencesexperiences ofof griefgrief andand lossloss.. ForFor exampleexamplelossloss ofof aa job,job, divorce,divorce, abortion,abortion, deathdeath ofof aalovelove one,one, severesevere physicalphysical oror mentalmental illness,illness,etcetc..


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TYPES OF CRISISTYPES OF CRISIS(Continuation)(Continuation)

Adventitious CrisisAdventitious Crisis-- are not part of everydayare not part of everydaylife. They are unplanned and accidental resultinglife. They are unplanned and accidental resultingin traumatic experiences. Such asin traumatic experiences. Such as Natural disasters.. hurricanes, flood, fire,Natural disasters.. hurricanes, flood, fire,

earthquake, etcearthquake, etc

National disasters.. war, riots, etcNational disasters.. war, riots, etc

Crime of violence.. Child abuse, rape, assault,Crime of violence.. Child abuse, rape, assault,bombing in crowded areas, etcbombing in crowded areas, etc


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CRISIS INTERVENTIONCRISIS INTERVENTION

GENERAL OVERVIEWGENERAL OVERVIEW

Crisis.Crisis.

Occurs in everyoneOccurs in everyone

Not necessarily pathological, may encourageNot necessarily pathological, may encouragegrowth and changegrowth and change

Time limited to a brief period, 4Time limited to a brief period, 4--6 weeks6 weeksexcept deathexcept death

A persons perception determines the crisisA persons perception determines the crisis


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Crisis interventionCrisis intervention

Is a short term therapy focused on solving theIs a short term therapy focused on solving the

immediate problem.immediate problem.

Limited to six weeksLimited to six weeks Goal is for the individual to return to a preciseGoal is for the individual to return to a precise

level of functioning .level of functioning .


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DefinitionDefinition

CrisisCrisis interventionintervention isis defineddefined asas thethe provisionprovision

ofof emergencyemergency psychologicalpsychological carecare toto victimsvictims asas

toto assistassist thosethose victimsvictims inin returningreturning toto anan

adaptiveadaptive levellevel ofof functioningfunctioning andand toto preventprevent oror

mitigatemitigate thethe potential potential negativenegative impactimpact ofof

psychologicalpsychological traumatrauma ..

EverlyEverly &&MitchelMitchel 19991999


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Basic principlesBasic principles

Intervene immediatelyIntervene immediately

StabilizeStabilize

Facilitate understandingFacilitate understanding

Focus on problemFocus on problem solvingsolving

Encourage self relianceEncourage self reliance


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GoalsGoals ReductionReduction inin disequilibriumdisequilibrium oror reliefrelief ofof

symptomssymptoms ofof crisiscrisis .. RestorationRestoration toto prepre crisiscrisis levellevel ofof functioningfunctioning

SomeSome understandingunderstanding ofof thethe relevantrelevant

precipitatingprecipitating eventsevents IdentificationIdentification ofof remedialremedial measuresmeasures throughthrough

communitycommunity resourcesresources

ConnectingConnecting thethe currentcurrent situationsituation withwith pastpast lifelifeexpexp andand conflictsconflicts

InitiatingInitiating newnew modesmodes ofof thinkingthinking ,, developingdeveloping

newnew adaptiveadaptive andand copingcoping responsesresponses..


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AssessmentAssessment

NeedNeed toto assessassess balancingbalancing factorsfactors areare importantimportantinin thethe developmentdevelopment andand resolutionresolution ofof aa crisiscrisis

1.1. PrecipitatingPrecipitating eventsevents oror stressorsstressors

2.2. Patients'Patients' perceptionperception ofof thethe eventevent oror stressorstressor

3.3. NatureNature andand strengthstrength ofof thethe patientspatients supportsupport

systemssystems andand copingcoping resourcesresources

4.4. PatientsPatients previous previous strengthsstrengths andand copingcoping

mechanismsmechanisms..


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Precipitating eventsPrecipitating events

NeedsNeeds ,, thethe eventsevents thatthat threatenthreaten thosethose needsneeds..

SelfSelf esteemesteem achievedachieved whenwhen thethe personperson attainsattains

successfulsuccessful socialsocial rolerole experienceexperience ..RoleRole masterymastery-- attainsattains work,work, sexualsexual andand familyfamily

rolerole successessuccesses

DependencyDependency satisfyingsatisfying interdependentinterdependentrelationshiprelationship withwith othersothers isis attainedattained

BiologicalBiological functionfunction-- safesafe andand lifelife isis notnot

threatenedthreatened


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Planning and implementationPlanning and implementation

Individualapproach

Generic

General

Environmental manipulation


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For TherapistsFor Therapists

See the client as they can beSee the client as they can be

Look for resources and strengths that can beLook for resources and strengths that can beuseful in transformationuseful in transformation

Normalize the fear, pain, sadness and sense ofNormalize the fear, pain, sadness and sense oflossloss

Support discovery, riskSupport discovery, risk--taking, curiosity, andtaking, curiosity, and

newly emergent patterns that promote wellnewly emergent patterns that promote well--being and growthbeing and growth

Look for the ponyLook for the pony


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TechniquesTechniques

CatharsisCatharsis

ClarificationClarification helpshelps toto identifyidentify thethe

relationshiprelationship betbet events,events, behaviorbehavior andand feelingsfeelings SuggestionSuggestion

ReinforcementReinforcement ofof behaviorbehavior

SupportSupport ofof defensesdefenses RaisingRaising selfself esteemesteem

ExplorationExploration ofof solutionssolutions


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Settings/modalitiesSettings/modalities

Mobile crisis programsMobile crisis programs

Group workGroup work-- widows groupwidows group

Telephone contactsTelephone contacts

Disaster responseDisaster response

Victim outreach programsVictim outreach programs

Health educationHealth education


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ASSESSMENTASSESSMENT

a.a. Perception of event: What happened that prompted you toPerception of event: What happened that prompted you toseek help?; How are you feeling now?; etc.seek help?; How are you feeling now?; etc.

b.b. Coping mechanisms: Suicidal?; Plans?; What helps you feelCoping mechanisms: Suicidal?; Plans?; What helps you feel

better?; etc.better?; etc.

c.c. Support systems: With whom do you live with?; Who isSupport systems: With whom do you live with?; Who isavailable to help you?; Who is most helpful?; etcavailable to help you?; Who is most helpful?; etc

d.d. Mental status, previous historyMental status, previous history

e.e. Identify clients strengthsIdentify clients strengths

f.f. SelfSelf--assessment: Nurses feelingsassessment: Nurses feelings


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Nursing Diagnosis:Nursing Diagnosis:

1.1. Risk self directed violenceRisk self directed violence

2.2. Chronic low self esteemChronic low self esteem

3.3. HopelessnessHopelessness4.4. PowerlessnessPowerlessness

5.5. Severe/Panic levels of anxietySevere/Panic levels of anxiety

6.6. Disturbed thought processDisturbed thought process

7.7. Sleep deprivationSleep deprivation

8.8. See textbook for additional diagnosisSee textbook for additional diagnosis


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Planning and outcome identificationPlanning and outcome identification

1.1. Assist the client in setting realistic goals toAssist the client in setting realistic goals toreturn to the prereturn to the pre--crisis level of functioningcrisis level of functioning

2.2. Establish desired outcome criteria for the clientEstablish desired outcome criteria for the clientusing the problem solving approach.using the problem solving approach.


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CRISIS INTERVENTION ContCRISIS INTERVENTION Cont

6.6. Use problem solving approach.Use problem solving approach.

7.7. Identify needed social support (with patients input) andIdentify needed social support (with patients input) andmobilize the most needed first.mobilize the most needed first.

8.8. Identify and work to increase needed coping skills (problemIdentify and work to increase needed coping skills (problemsolving, relaxation, assertiveness, job training, newborn care,solving, relaxation, assertiveness, job training, newborn care,selfself--esteem).esteem).

9.9. Plan with patient interventions that are acceptable to both.Plan with patient interventions that are acceptable to both.

10.10. Evaluate plan and instruct patient with alternative plan ifEvaluate plan and instruct patient with alternative plan if

needed.needed.


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crisis intervention for 1 mscn