Differences Between Crisis Counseling Strategies and Psychotherapy

Introduction

Differences between crisis counseling strategies and psychotherapy 

On the surface it may at first appear that crisis counseling and psychotherapy are so similar that the only distinctions are the setting and circumstance in which they occur.   It is easy to see how that conclusion might be reached.  This is especially true when we look through the lens of someone who is untrained or unfamiliar with the therapeutic techniques that are used in crisis counseling or psychotherapy.  At the core they both employ strategies and methods designed to assist people dealing with a trauma.  However, as we look deeper and focus on how each is defined and the strategies and techniques that each uses, the differences between the two become more apparent.  

Hoff, Hallisey and Hoff (2009) suggest that although crisis care is not synonymous with psychotherapy it does employ some similar techniques such as, listening and catharsis (p 22).  An important distinction between the two is that the goals and outcomes are not the same.  Psychotherapy can be defined as “A helping process directed toward changing a person’s feelings and patterns of thought and behavior.” (Hoff, Hallisey, & Hoff, 2009, p. 498).  Psychotherapy is provided by trained and licensed mental health professionals and is usually long term in nature.  There are many different treatment modalities that are used in psychotherapy, the one that is used will be determined by the reason the individual is seeking therapy. 

By contrast crisis counseling does not require the counselor have any formal training or certification and is often performed by first responders, clergy, medical staff and others who come in contact with the individual in crisis.  A crisis for an individual is defined by Hoff, Hallisey and Hoff (2009)  as “a state of  acute emotional upset in which one’s usual problem-solving ability fails”,  it further goes on to explain that this failure occurs as a response to a traumatic event, such as; loss of a loved one, divorce, accident or victimization (Hoff, Hallisey, & Hoff, 2009, p. 495).    Unlike psychotherapy, crisis counseling is short term in nature and focuses on problem solving strategies the individual can use to resolve the crisis. A major part of the strategy is assessing the individual and assisting them with identifying a plan to resolve the crisis.

Dangers of a full-blow crisis state

This brings us to our second question,

 When dealing with individuals that are in crisis the escalation to a full-blown crisis state can have serious consequences and may present a danger to all involved.   When in crisis,, an individual’s response may be out of character to how they would normally respond to a situation this can result in behaviors and actions that present serious harm to themselves or others.   Consider the example provided in “On-scene mental health counseling provided through police departments” in this article we are presented with a situation where a young woman is witness to her mother’s suicide (Young, A. T., Fuller, J., and Riley, B., 2008),  It is important to understand the role of both crisis intervention and psychotherapy in a situation such as this.   As discussed earlier, there are similarities between crisis counseling and psychotherapy, both utilize listening and allowing the individua a safe space to express their feelings.   However, there is a dissimilarity as well, crisis intervention is short term in nature, it is meant to first assess the individual and provide strategies and referral sources to help the individual manage their crisis.  Effective crisis intervention must also be cognizant of cultural differences as well as, value differences that may exist between the individual and the person providing crisis intervention.   Effective crisis intervention requires that we establish trust and rapport, “It is important to remember in crisis work that for many people certain values are worth dying for.  Needless to say, if an imposed—rather than a negotiated—crisis management plan contradicts dearly held values and threatens a person’s sense of self-mastery, the changes of success are minimal” (Hoff, Hallisey & Hoff, 2009, p. 111).

In Christian crisis counseling this may seem to go against the natural desire to minister to the individual and provide counseling from the Christian perspective.   As stated previously, this approach may result in distrust and cause more harm to the individual then help.   Christians who respond to individuals in a Christ like manner demonstrate the true teachings of Jesus.  In the Sermon on the Mount, there is a passage that exemplifies this, it clearly shows that by simply doing God’s work we are ministering by our actions not our words. “¹⁴ You are the light of the world—like a city on a hilltop that cannot be hidden. ¹⁵ No one lights a lamp and then puts it under a basket. Instead, a lamp is placed on a stand, where it gives light to everyone in the house. ¹⁶ In the same way, let your good deeds shine out for all to see, so that everyone will praise your heavenly Father.” (Matthew 5:14-16, New Living Translation).  Using this as a guide provides the Christian counselor the ability to respectfully provide meaningful crisis interventions to individuals that hold different beliefs.

Strategies to deal with the victim-rescuer-persecution triangle.

 In our third and final question we are asked…..

The victim-rescuer-persecution triangle is also known as the Karpman drama triangle (Karpman, 1968).  Karpman describes the drama triangle as having three roles, the victim, the persecutor, and the rescuer and uses fairy tales to demonstrate how the roles change as the drama plays out, the victim becomes the rescuer, persecutor becomes the victim and so on.   A more concise and expanded description of the drama triangle and its roles  is offered by Shmelev (2015) he states, “ The model itself describes three habitual psychological roles, which people change depending on the situation:”  He goes on to define these roles as, “ the role of the Victim, in which the performer projects the causes of problems and sufferings onto other people, events and circumstances; – the role of the Persecutor, in which one pressurizes, forces and persecutes the victim; – the role of the Rescuer, in which one interferes out of a seeming willingness to help.”  (Shmelev, 2015, p 134).

The triangle occurs naturally and regularly in human relationships, particularly in helping relationships. (Hoff, Hallisey & Hoff, 2009).   Counselors themselves can become a part of the triangle, this can occur when the client is not responding to therapy in the way the counselor feels is appropriate, in this situation the counselor can become frustrated and become the persecutor, blaming the client for failing to respond to the therapy.  At this point the victim or client becomes the persecutor and punishes the counselor for not helping thus perpetuating the victim-rescuer persecution triangle (Hoff, Hallisey & Hoff, 2009, p. 130).   

When an individual has become enmeshed in the victim-rescuer-persecution triangle it is difficult for them to clearly see and understand the dynamics that are at play.  Counselors can help these individuals by using strategies that reinforce personal responsibility. “One of the most important tasks of the counselor becomes the strengthening and reinforcement of the Self of the client via the client’s undertaking of responsibility for his own self, his life and the situation in the first place, and then for the lives of others (family, business, people surrounding him). A psychotherapist or a coach needs to keep in mind that when the client becomes aware of her capabilities and inner strength of the Self, which stems out of personal authorship in the theater of life, it “brings the person back home to herself”. As a result, the client takes control of her behavior and gets the opportunity to become the author and painter of her own life events and to organize life based on her own choices and decisions.” (Shmelev, 2015, p 140-141).

References

• Hoff, L. A., Hallisey, B. J., & Hoff, M. (2009). People in crisis: Clinical and diversity perspectives. New York: Routledge.
• Karpman, S. (1968). Fairy tales and script drama analysis. Transactional analysis bulletin, 7(26), 39-43.
• Shmelev, I. M. (2015). Beyond the drama triangle: The overcoming self. Psychology. Journal of Higher School of Economics, 12(2), 133-149.
• Young, A. T., Fuller, J., & Riley, B. (2008, October). On-scene mental health counseling provided through police departments. Journal of Mental Health Counseling, 30(4), 345+. Retrieved from http://link.galegroup.com.ezproxy.liberty.edu/apps/doc/A188489918/AONE?u=vic_liberty&sid=AONE&xid=531bc545