Reflections of a Trauma Nurse/Counsellor’s Academic, Research & Clinical Experiences Crisis Counselling Intervention Strategies

Crisis states, grief work and bereavement are phenomenal experiences and a short period of decompression for the bereaved to feel safe, secure and regroup is critical.  Then, the bereaved can move into acceptance, sharing their pain inherent in loss, dealing with their memories of the lost person, status or object(s).  Open expression of pain, sorrow, hostility, and grief means being free to feel and mourn one’s loss(s) openly, usually by weeping, and to express one’s feelings.  To understand the intense feelings associated with loss means facing the fear of going crazy and a normal part of the grieving process

When feelings of sorrow, fear, guilt, and hostility are worked through in the presence of a caring person, these feelings gradually subside and the rituals to express grief aids in this process.  Resuming normal activities and social relationships without the lost person, status or object(s) at one’s side is another important step.  Working through the memories and feelings associated with loss helps the bereaved obtain new patterns of social interaction apart from the person, status, and object(s) that are gone.

Crisis Counselling Intervention Steps:

1)      Listen actively and with concern.  A good listener dispels feelings of being ashamed or worry about one’s ability to cope no matter how minor or major the problems appear.  Effective listening demands attention, so communication is the key to acknowledge what the bereaved are saying, to encourage more talking, and build rapport and trust.  Failure to listen forms a barrier to all other possible interventions.

2)      Encourage the open expression of feelings is an important, natural crisis intervention strategy to circumvent build up, bottled up feelings of anger, grief, frustration, helplessness, and hopelessness.  Crisis counsellors accept negative associations (transference) during expressions of traumatic events that have occurred, and this generally helps the bereaved feel better immediately plus is the beginning of healthier coping styles in the future.  For people in crisis who are fortunate enough to get the help they need, this is one of the rewarding growth possibilities achieved during grief work.

3)      The next 6 crisis steps focus on crisis resolution:

Help the person gain understanding of the crisis/loss – crisis counsellors help people see the many factors that contribute to the crisis situation to curtail self/other blaming.  The bereaved are encouraged to examine the total problem, including self/other’s behaviours as related to the crisis.  Thoughtful reflection on one’s/others behaviours leads to growth and change rather than self/other deprecation and pity.

Help the person gradually accept reality – respond to people who tend to blame their problems on others.  People in crisis may adopt the role of victim and counsellors can help them escape that role.  If a crisis stems from social sources, the bereaved are victimized, not only abuse, they are survivors and their survival skills need to be tapped into for constructive resolution by encouraging them to channel their anger into action to change oppressive social arrangements and social policies, justice.

Defense mechanisms – blame and scapegoating is especially strong in family and marital crisis and it is the counsellors’ work to help these folks understand that the victim/persecutor relationships are not one-sided.  Establishing good grief working relationships with the bereaved with genuine concerns and not engaging in rescue roles or fantasies helps people accept a counsellors interpretation of their role in the crisis event.  It is common in the Victim Triangle Syndrome www.mental-health-today.com/articles/drama.htm to occur frequently in human relations, so counsellors who try to help people who perceive themselves to be victims are usually frustrated when their efforts fail and the victim returns to the persecutor and punish the counsellor for well-intentioned, but inappropriate effort to help people who do not ask for the help.

Link people to social networks – loss(s) disrupt social ties and a precursor of crisis states, so restoration of ties and formation of new ties is a powerful means towards resolve.  Crisis counsellors take an active role in helping the bereaved re-establishing themselves in their social networks.

Reinforce newly learned coping skills, and follow-up after crisis resolution – provide the bereaved in crisis with time to plan and try any proposed solutions related to the problem.  Successful problem-solving mechanisms are reinforced; unsuccessful solutions are discarded, and new ones are sought. In all cases, people in crisis states ought not to be cut-off from supports abruptly!

During initial crisis plans have a follow-up contract – when a person initiates or gets involved in a helping process, ensure follow-up is included and is a mutually negotiated, total service plan/contract that is based on the principles of self-determination without denigration of anyone’s role, function, values, and abilities to partake in crisis resolve.  The bereaved bring their grief within context and the crisis counsellor is responsible for the contract process.

It is important to complete a risk assessment in crisis counselling and know the increased risk/use of maladaptive coping behaviors and the risk factors of premature death associated with widows/widowers during the first year of bereavement.  Grievers appreciate knowing about maladaptive coping behaviors and the inherent risk factors for the acutely bereaved verses getting blind-sided and taken advantage of, when vulnerable and unprepared. 

I have learned that grievers who get to the depths, complete their grief work become great lovers of life.

Author:  Dr. Linda AK Thompson, BGS, MA, CCC, PsyD, FAAETS   Owner, Matrix of Trauma (© MOT ™):  Research, Advocacy, Healing

Reference:

Hoff, Lee A. (1995).  People in Crisis – Understanding and Helping.  Jossey-Bass Inc. CA. ISBN: 0-7879-0084-2

 

*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA