Crisis Intervention Strategies, Ninth Edition
Richard K. James, Julia Whisenhunt and Rick A. Myer
Contents
1 Basic Training:
Crisis Intervention Theory and Application 1
Chapter 1
Approaching Crisis Intervention 2
A Brief History of Crisis Intervention 2
Grassroots Movements 4
The Importance of Volunteerism 5
The Need for Institutionalism 5
The Media and the Societal Impetus for Crisis
Intervention 6
COVID-19 and the Rise of Telebehavioral Health 8
A Positive Shift in Attitude 8
The Case Against Too Much “Helping” 8
Definitions of Crisis 9
Individual Crisis Definitions 9
Behavioral Emergencies 10
Systemic Crisis Definitions 10
Mega Crisis 11
Metastasizing Crisis 12
Characteristics of Crisis 12
Transcrisis States 13
Transcrisis Differentiated from Posttraumatic
Stress Disorder 14
Transcrisis Points 15
Theories of Crisis and Crisis Intervention 15
Basic Crisis Intervention Theory 15
Expanded Crisis Theory 16
Applied Crisis Theory 20
Crisis Intervention Models 21
The Equilibrium Model 21
The Cognitive Model 21
The Psychosocial Transition Model 21
The Developmental-Ecological Model 22
The Contextual-Ecological Model 22
Psychological First Aid 22
The ACT Model 23
Playbook/Game Plan Model 24
Eclectic/Integrated Crisis Intervention
Theory 24
Characteristics of Effective Crisis Workers 25
Life Experiences 25
Personal Characteristics 26
Rewards 27
Summary 28
Chapter 2
Culturally Effective
Helping in Crisis 30
Multicultural Perspectives in Crisis
Intervention 30
Core Multicultural Attributes 32
Culturally Biased Assumptions 33
Universal Versus Focused Views 35
Working on the Individualist/Collectivist–High/
Low-Context Continuum 36
Emic Versus Etic Models of Multiculturalism 38
Awareness of Both Ecology and Multicultural
Competencies 42
Toward Culturally Effective Helping During a
Crisis 43
Culturally Effective Helping 44
Positive Aspects of an Effective Multicultural
Counselor 46
When in Rome, Italy . . . or Georgia 47
Language Barriers 48
Religion and Spirituality 48
Support Systems 50
Occupation as a Cultural Barrier 51
Geographic Locale as a Cultural Barrier 51
The Dilemma of Local Consultation 52
The Necessity of Acting 53
Training 53
Where It Stands Now . . . Sorta 53
Summary 54
Chapter 3
The Intervention and
Assessment Models 55
Introduction 55
A Hybrid Model of Crisis Intervention 56
Task 1. Predispositioning/Engaging/Initiating
Contact 57
Task 2. Problem Exploration: Defining
the Crisis 59
Task 3. Providing Support 59
Default Task: Safety 61
Task 4. Examining Alternatives 61
Task 5. Planning in Order to
Reestablish Control 62
Task 6. Obtaining Commitment 64
Task 7. Follow-up 64
Assessment in Crisis Intervention 65
Assessing the Severity of Crisis 66
The ABCs of Assessing in Crisis Intervention 66
The Triage Assessment System 67
The Triage Assessment Form 67
Alternate Forms of the TAF 75
Default Drug Assessment 76
Default Lethality Potential Assessment 77
Assessing the Client’s Current Emotional
Functioning 77
Assessing Alternatives, Coping Mechanisms, and
Support Systems 79
Assessing for Legal and Ethical Issues 79
Assessment 81
Setting 81
Ethical Principles 82
Resolution 83
Summary 83
Chapter 4
The Tools of the Trade 85
Introduction 85
Listening in Crisis Intervention 85
Open-Ended Questions 85
Closed-Ended Questions 86
Restatement and Summary Clarification 87
Owning Feelings 87
Facilitative Listening 90
Basic Strategies of Crisis Intervention 92
Climate of Client Growth 94
Communicating Empathy 94
Communicating Genuineness 98
Communicating Acceptance 99
In the Field 100
Acting in Crisis Intervention 101
Directive Intervention 102
Collaborative Counseling 102
Nondirective Counseling 103
Action Strategies for Crisis Workers 103
Summary 108
Chapter 5
Crisis Case Handling 109
Handling Crisis Cases Versus Long-Term
Cases 109
Case Handling at Walk-In Crisis Facilities 110
Types of Presenting Crises 110
Case Handling at a Community Mental Health
Clinic 114
Police and Crisis Intervention 116
Changing Role of the Police 117
Police and People with Mental Health Crises 117
The Crisis Intervention Team (CIT)
Program 118
Sequential Intercept Model (SIM) 123
Transcrisis Handling in Long-
Term Therapy 125
Anxiety Reactions 125
Regression 126
Problems of Termination 127
Crisis in the Therapy Session 127
Psychotic Breaks 128
People With Borderline Personality
Disorder (BPD) 129
Counseling Difficult Clients 134
Ground Rules for Counseling Difficult
Clients 134
Confronting Difficult Clients 135
Confidentiality in Case Handling 135
Summary 136
Chapter 6
Telephone and Online Crisis
Counseling 137
Introduction 137
Case Handling on Telephone Crisis Lines 138
Telephone Counseling Strategies 140
Making Psychological Contact 140
Defining the Problem 141
Ensuring Safety and Providing Support 142
Considering Alternatives and Making Plans 143
Obtaining Commitment 143
Errors and Fallacies 144
Regular, Extremely Distressed, and Abusive
Callers 145
Understanding the Regular Caller’s Agenda 146
Handling the Extremely Distressed Caller 148
Other Problem Callers 151
Handling the Problem Callers 153
Hotlines 155
Tele-Behavioral Health Growing Role in Crisis
Intervention 156
The Appeal of Online Counseling 158
Problems of Legal and Ethical Issues
in Tele-behavioral Health 159
Netiquette 161
Predispositioning/Making Contact 162
Need for Training 164
Does It Work? 165
Summary 165
2 Handling Specific Crises:
Going Into the Trenches 167
Chapter 7
Posttraumatic Stress Disorder 168
Introduction 168
History 169
Terminology 169
Summary of Diagnostic Criteria 172
Complex PTSD 175
The Question of Preexisting
Psychopathology 176
Neurophysiological Responses 177
Affective-State-Dependent Retention 178
Children and Neuropathology 178
Incidence, Impact,
and Trauma Type 178
Incidence 178
Residual Impact 179
Importance of Trauma Type 180
Vietnam: The Combat Archetype 180
Intrusive-Repetitive Ideation 185
Denial/Numbing 185
Increased Nervous Symptom Arousal 186
Dissociation 186
Social Supports 187
Maladaptive Patterns Characteristic of PTSD 188
The Traumatic Wake of Iraq and Afghanistan 190
The Comprehensive Solider Fitness Program 191
Components of Treatment for Adults 192
Assessment 192
Phases of Recovery 197
Importance of Acceptance 197
Risks of Treatment 199
Multiphasic/Multimodal Treatment 199
Psychotropic Medication 203
Individual Intervention Stages 203
Emergency/Outcry 203
Extinguishing Intrusive Images 204
Numbing/Denial 204
Reflection and Transition 207
Integration 208
Group Treatment 208
Support Groups 209
The Life Adjustment Group 215
Family Treatment 215
Eye Movement Desensitization and Reprocessing
(EMDR) 216
The Controversy over EMDR 216
EMDR Therapy 217
Children and PTSD 220
Diagnostic Criteria for Children 220
Support Systems 221
Types of Trauma 222
Etched Memories 222
Developmental Issues 223
Other Responses to Type I Trauma 224
Type II Traumas 225
Intervention Strategies 225
Therapy 226
Final Words on the Case of Carlos 228
Moving Beyond the Trauma 229
Summary 230
Chapter 8
Crisis of Lethality 232
Background 232
The Scope of the Suicide Crisis 233
Suicide and the Moral Dilemma 234
Euthanasia 235
The Dynamics of Suicide 236
Psychological Theories 236
Sociological Theory 237
Other Explanations 238
Characteristics of People Who Complete
Suicide 240
Similarities Between Suicide and Homicide 240
Analyzing Suicide/Homicide Notes 241
Myths About Suicide 242
Assessment 244
Suicide Clues 244
Warning Signs 244
Risk Factors 245
Assessment Instruments 246
Using the Triage Assessment Form
in Addressing Lethality 248
Intervention Strategies 250
The Three I’s 250
Crisis Management 254
Older Adults 261
Guidelines for Family, Friends,
and Associates 264
Some “Don’ts” and a Few “Dos.” 265
The Psychological Autopsy 266
Postvention 267
Child Survivors 267
Parent Survivors 268
Support Groups 268
Transcrisis Postvention 269
Losing a Client to Suicide 271
Summary 271
Chapter 9
Sexual Assault 273
The Scope of the Problem 273
Underreporting 275
Defining Rape: The Unique Situation
of Sexual Abuse/Rape Survivors 275
The Dynamics of Rape 276
Social/Cultural Factors 276
Personal and Psychological Factors 276
Myths About Rape 277
Date and Acquaintance Rape 280
Candy Is Dandy, but Liquor Is Quicker—
and More Violent 281
Preventing Date, Acquaintance,
and Other Forms of Rape 281
Intervention Strategies for Rape and Battery: The
Case of Melody 283
Immediate Aftermath 283
Using Support Systems and Stopping Secondary
Victimization 286
Responses 288
The Following Three Months 288
PTSD 288
Critical Supports 289
Adult Survivors of Childhood Sexual Abuse 290
Psychological Trauma and Sequelae 290
False Memories 291
Intervention Strategies for Adult Survivors: The
Case of Heath 292
Assessment 293
Support Groups for Adult Survivors. 301
Religiosity and Spirituality 301
Sexual Abuse in Childhood 302
The Numbers 302
Dynamics of Sexual Abuse in Childhood 303
Dynamics of Sexual Abuse in Families 304
Phases of Child Sexual Abuse 306
Intervention Strategies with Children 308
Therapeutic Options 308
Intervention Strategies for Child Sexual Abuse:
The Case of Elizabeth 312
Disclosure. 312
Prosecuting the Perpetrator 315
Aftermath 317
Counseling 317
Group Support Work with
Nonoffending Parents 317
Summary 319
Chapter 10
Partner Violence 320
Introduction 320
The Incidence of Partner Violence 321
Emerging Approaches to Partner Violence 323
Dynamics of Partner Violence 324
Psychosocial and Cultural Dynamics 324
Psychological Factors 327
Myths About IPV 330
Profiling the IPV Perpetrator 331
The Cycle of Violence 331
Realities for Abused Individuals 332
Intervention Strategies 333
Assessment 333
Crisis Lines 335
Components of Intervention 336
Shelters 344
Shelter Dynamics 345
Follow-Up 348
Intervention with Children 348
Teen Dating Violence 351
Stalking 351
Cyberstalking 352
Treating IPV Perpetrators 353
The Duluth Model 354
Summary 356
Chapter 11
Family Crisis Intervention 357
Introduction 357
Definition of Family Crisis 358
Transcrisis 360
Research on Family Crisis 360
Medical Crises 361
Disaster Recovery 361
Family Crisis Models 362
Types of Crisis Families Encounter 365
Dynamics of Family Intervention 367
Case Vignette 371
Hybrid Model Applied to Families 371
Stages of Family Resolution of Crises 385
Cultural Issues 391
Summary 391
Chapter 12
Personal Loss
Bereavement and Grief 392
Introduction 392
Terms Critical to Understanding Loss 394
Dynamics of Bereavement 397
Cultural Dynamics 397
Sociocultural Mores 398
Spirituality and Religion 399
Conceptual Approaches to Bereavement 400
Stage/Phase Models 400
A Counterpoint to Traditional Models 401
Assessment Tools 403
Types of Loss 404
Death of a Spouse 404
Loss Due to Caregiving 405
Death by Euthanasia 406
Death of a Child 407
Bereavement in Childhood 408
Intervention and Treatment 409
Bereavement in Adolescence 410
Bereavement in Older People 411
COVID Isolation 412
Job Loss 413
Separation and Divorce 414
Death of a Pet 414
Prolonged Grief Disorder, Bereavement, and
Mourning Reaction 415
Intervention Strategies 417
Being There for Grievers: A Worker
Imperative 417
Fitting Technique to Style of Grief 418
Cognitive-Behavioral Approaches 420
Constructivist Approaches 420
Attachment Theory and Therapy 420
Dealing With Loss 420
Sudden Death of a Spouse 420
Traumatic Death of a Child 424
First Crisis Session 3 Months After
Gene’s Death 425
Second Crisis Session 1 Week Later 428
Third Crisis Session a Week Later 429
Bereavement in Childhood 430
Separation and Divorce 433
Death of a Pet 437
Bereavement in Older People 439
Complicated Grief: Death of a Mother 441
The Crisis Worker’s Own Grief 445
Is There Any Lemonade in All These Sour
Lemons? 446
Summary 447
Chapter 13
Crises in Schools 449
The New-Millennium, Violence-Proof School
Building 449
Conflicting Statistics 452
Violence and Youth 454
Gangs 455
Types of Gangs 455
Emergence of Suburban and Rural Gangs 456
Gang Intervention/Prevention Programs 457
School Resource Officer 461
Bullying 464
Cyberbullying 465
Bystander Training 467
The Estranged Violent Juvenile Offender 469
A Comparison of Traits, Characteristics, and
Behaviors of SVJOs and EVJOs 470
Case Study: Seung-hui Cho 475
Screening the EVJO 475
Interviewing the Potential EVJO 477
Scenario 1 479
Scenario 2 479
Acting 481
School-Based Suicide Prevention and
Intervention 481
Risk Factors/Predictors/Cues 483
Preadolescent Suicide 484
Child and Adolescent Cases of Suicidal
Ideation 484
Postvention 487
Crisis Intervention and the Tier System 491
Planning for a Crisis with
the SCRT 492
The School Crisis Response Team (SCRT) 495
Implementing the Crisis Plan 497
Physical Requirements 497
Logistics 497
Responding to the Crisis 498
Grief and Memorializing Schools 501
Group Work 503
Defining the Boundaries 505
Transcrisis Intervention with Individuals and the
Total School System 505
The Case of Josh 506
Epilogue 508
Summary 510
3 On the Home Front:
Crisis in the Human Services Workplace 511
Chapter 14
Violent Behavior in Institutions 512
Warning 512
Precipitating Factors 514
Institutional Culpability 516
Universities and Their Counseling Centers 516
Denial 517
Staff Culpability 518
Ethical and Legal Liability 519
Dynamics of Violence in Human Services
Settings 520
Violence Potential Assessment Instruments 520
Structured Professional Judgment 521
Bases for Violence 523
Intervention Strategies 527
Security Planning 527
Threat Assessment Teams 528
Training 530
Record Keeping and Program Evaluation 534
Stages of Intervention 534
The Violent Older Client 544
Mild Disorientation: The Case of Cliff 545
Distinguishing Between Illusions
and Hallucinations 548
Disorientation with Dementia: The Case of
Grace 550
Follow-up With Staff Victims 551
Summary 553
Chapter 15
Human Services Workers in Crisis
Burnout, Vicarious Traumatization,
and Compassion Fatigue 554
Burnout 554
Helping Professionals: Prime Candidates 555
Dynamics of Burnout 556
Cornerstones of Burnout 557
Research on Burnout Dynamics 558
Myths That Engender Burnout 559
Symptoms of Burnout 560
Levels of Burnout 560
Stages of Burnout 560
Worker–Client Relationships 562
The Culpability of Organizations 566
Self-Recognition of Burnout 567
Assessment 567
Intervention Strategies 568
Private Practitioners and Burnout 578
Intervention with the Individual: A Case
Study 579
The Client 580
Ethical Issues 581
Assessment 582
Intervention 583
The Next Week 586
Vignette Summary 588
Summary 590
4 No Man’s Land:
Facing Disaster 591
Chapter 16
Disaster Response 593
Types of Disasters 593
A Brief History of Disaster Mental Health
Provision 595
Where the World Is 599
International Terrorism and Human-Made
Disasters 599
New Directions and New Visions 601
System Overview 603
Microsystem 603
Mesosystem 603
Exosystem 607
Macrosystem 607
Chronosystem 608
The Society 611
Defining Principles of a Crisis Intervention
Ecosystem 612
National Crisis Response Teams 614
Mental Health Components of Local EMAs 621
What Happened With Katrina? 622
What about COVID-19? 624
Psychological First Aid and Psychosocial Support
as Applied to Disaster Survivors 625
When More Than PFA Is Needed 625
The Current State of Affairs 626
The People of Disasters: Responders and
Survivors 628
Crisis Workers at the Disaster 628
Thoughts of a Mental Health Worker on Katrina
One Year Later 628
Lessons I Learned From Katrina 631
9/11 What No Class Prepared Me For 632
Case Study of the Benefield Family 633
Tuesday, April 21, 14:00 Hours Military Time
(2:00 p.m. CDT) 633
April 21, 14:15 Hours Military Time (2:15 p.m., 15
minutes After the Tornado) 634
April 21, 14:25 Hours, Emergency Command
Center 634
April 21, 14:35 Hours, Midville Middle School, School
Crisis Response Team Meeting in Cafeteria 634
April 21, 15:05 Hours, above Midville in a
helicopter 635
April 21, 15:21 Hours, Command Center 636
April 21, 15:51 Hours, Midville Elementary
School 636
April 21, 15:30 Hours, EOC Command Center 637
April 21, 15:35 Hours 637
April 21, 17:12 Hours 638
April 21, 18:23 Hours 638
April 21, 19:02 Hours, Midville Civic Center 638
April 21, 19:22 Hours, Civic Center Reception and
Clearing Area 640
April 22, 08:35 Hours, National Guard Armory
Disaster Shelter 640
April 22, 09:42 Hours, Seabrook Packing Plant
Temporary Morgue 641
April 24, 11:00 Hours, Hatchie County Mental
Health Center 642
April 25, 18:00 Hours, High School
Gymnasium 642
April 30, 16:00 Hours, Hatchie County Mental
Health Center 644
May 8, 09:00 Hours, Midville Baptist Church
(Temporary Site for Midville Elementary
School) 645
May 15, 16:00 Hours, Hatchie County Mental
Health Center 646
May 22, 16:00 Hours, Hatchie County Mental
Health Center 646
April 25 (1 year and 4 days after the tornado),
16:00 Hours, Hatchie County Mental Health
Center 647
Multiculturalism at Work 648
Spiritualism/religion 649
Focus on the Worker 650
Debriefing Models 650
Debriefing Emergency Workers 651
Debriefing Crisis Workers 653
Final Thoughts 656
Summary 656
References 658
Glossary 754
Index 762