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In this section, we will discuss two factors concerning identifying a crisis. These two factors are definitions of crisis, and key elements of crisis. We will also discuss the common denominators assessment tool.
To begin discussing the process of helping clients in crisis, I would like to spend the rest of this track reviewing the basic definitions for assessing hallmarks of a client in crisis.
As you know, a first factor in identifying a crisis is understanding working definitions of the term crisis itself. Perhaps the most commonly quoted definition of crisis comes from Caplan, who indicated, a state "provoked when a person faces an obstacle to important life goals that is, for a time, insurmountable through the utilization of customary methods or problem solving."
Crisis according to Caplan is characterized by the fact that for the client, the circumstances of the crisis situation are such that her or his usual ways of solving threatening problems are not working. Therefore, according to Caplan, crisis refers to the individual’s reaction to the situation, rather than the situation itself.
Identifying a Crisis - 2 Factors
♦ 1. Defined by a Precipitating Event
A crisis might also be defined by a precipitating event, although clearly not all crises will have precipitating events clearly defined. According to Freeman, there are five distinctive categories of precipitating events.
Five Categories of Precipitating Events:
1. Object loss, the threat of object loss, or the loss of the opportunity to restore objects
2. Loss of previous sources of help
3. A client becomes so identified with another that the inability to distinguish between his or her own state and the other’s produces a crisis
4. A surge of "unmanageable impulses,"
5. A threat to current adjustment
♦ 2. Key Elements
A second factor in identifying a crisis are the key elements of a crisis. One of these key elements is that although identifying a precipitating factor is very helpful, the presence or absence of such an event is not a safe indicator of crisis. According to Getz in his book "Fundamentals of Crisis Counseling," this is because some clients are unable to determine just what has happened to throw them off course, or they may be unwilling to share a private experience.
Unwillingness to share this precipitating event may be due to resistance, embarrassment, or the fear of punishment. However, as you have experienced, the precipitating event need not be clear at first for successful therapy to take place.
Getz also points out that an additional key element in identifying crisis is using caution in attempting too specifically to defining a crisis and establish the potential crisis’ confirmation to all of the diagnostic criteria. Clearly, if a client envisions him or herself in crisis or intense stress either in reality or in fantasy deserves attention. It goes with our saying, while diagnostic criteria of course are valuable, in the end the client and therapist must determine what constitutes a crisis for that specific client.
♦ Technique: 5 Common Denominators Assessment
I frequently use the Common Denominators Assessment technique as a guideline to help identify clients in crisis. The five factors in this assessment technique are based on the work of Miller.
-- 1. The Time Factor: general consensus among therapists is that a crisis is acute rather than chronic.
-- 2. Marked Changes in Behavior: the individual or group therapy is obviously less effective than usual. Client activity is mainly related to attempts to discharge inner tensions, there are successive trial and error abortive attempts to solve the problem without apparent success. Constructive behavior decreases, and frustration mounts. It is usually at this time that scapegoating and excuse giving occurs.
-- 3. Subjective Aspects: The person experiences feelings of helplessness and ineffectiveness in the face of what appears to be insoluble problems. There is a perception of threat or danger to important life goals the client has and this is accompanied frequently by anxiety, fear, guilt, or defensive reactions.
-- 4. Relativistic Aspects: Although there are common crisis situations, such as the death of a loved one, the loss of a job, or a sudden disabling accident, the individual’s perception of threat and of a crisis is of course unique to her or him. What may constitute a crisis for your client may not constitute a crisis for another individual or group.
-- 5. Organismic Tension: The client in crisis will experience generalized physical tension which may be expressed in a variety of symptoms, including those commonly associated with anxiety. These reactions may be immediate or temporary, or they may constitute a long-term adjustment to the crisis situation itself.
Think of a client in crisis whom you are currently treating. Do the five factors in the common denominators assessment technique fit her or him?
In this section, we have discussed two factors concerning identifying a crisis. These two factors are definitions of crisis, and key elements of crisis. We have also discussed the common denominators assessment technique.
Peer-Reviewed Journal Article References:
Andrews, M. (2016). The existential crisis. Behavioral Development Bulletin, 21(1), 104–109.
Doki, S., Kaneko, H., Oi, Y., Usami, K., Sasahara, S., & Matsuzaki, I. (2016). Risk factors for suicidal ideation among telephone crisis hotline callers in Japan. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 37(6), 438–444.
Faubert, S. E. (2020). Review of Crisis intervention: Building resilience in troubled times [Review of the book Crisis intervention: Building resilience in troubled times, by L. G. Echterling, J. H. Presbury & J. E. McKee]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(3), 237–238.
What are the five categories of precipitating events to a crisis?
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