Crisis Intervention: Solution Orientated Brief Therapy
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The theory of solution-oriented brief therapy is particularly suited to crisis intervention. Kanel (2007) explores this perspective when she describes the brief therapy approach in the crisis setting stating, "Brief therapy seems to be as effective as long-term therapy" (p. 23). Since crisis situations are time sensitive, solution-oriented crisis intervention becomes practical because it focuses on quick assessment and creative change. Greenstone (2002) emphasizes that, "Crisis Intervention/Management is an attempt to deal quickly with an immediate problem" (p.1). Given the nature and needs of crisis situations the intervener may approach the encounter in a structured manner that assesses need, recognizes inherent dangers, suggests creative change, and facilitates a positive course of action. Positive reinforcement of the intervention can also be achieved through referral and/or follow-up.
The Nature of Crisis Intervention
A crisis intervener seeks to posture himself in a helping relationship with the counselee in order to arrest maladaptive behavior. The idea of maladaptive behavior is suggested by Greenstone (2002) and he reinforces the point that this results when the victim can no longer deal with mounting stress and as a result, their coping mechanisms begin to fail. In crisis situations, the immediacy and timeliness of the intervention is all-important. Greenstone (2002) suggests, "The intervener's skill and the timeliness of intervention can determine the possibility of the victim's later functioning and growth" (p. 1). The object of a crisis intervener is then to facilitate the counselee through the difficulties of a crisis and to assist them in choosing a direction that will allow them to once again function in life more proficiently. This can be accomplished by helping them to cope with crises and developing resiliency. Brammer (2003) accurately defines this helping relationship stating, "Helping another human being is basically a process of enabling that person to grow in the directions that person chooses, to solve problems, and to face crises" (p. 4).
Issues of Immediacy
Crisis Intervention can be approached singly or as a team. In either case, the responsibilities and procedures are the same. The Bible teaches that we are called to "bear one another's burdens and so fulfill the law of Christ" (Ga. 6:2, KJV). A crisis counselor is always looking for a way to help. One thing that is consistent in approaching a crisis is that the immediacy of the intervention affects the outcome. Greenstone (2002) notes this stating, "In approaching a crisis, the immediacy of the intervention is vital; The [intervention] team must attempt to relieve anxiety, prevent further disorientation, and ensure that the victims do not harm themselves or others" (p. 37).
Seeing the need to address the issues of immediacy in Crisis Intervention, the National Child Traumatic Stress Network, and the National Center for Post-Traumatic Stress Syndrome have developed a modular approach to help children, adolescents, adults and families. Brymer & Company (2006) suggest that this is "to reduce the initial stress caused by traumatic events and to foster short and long-term adaptive functioning and coping" (p.5). This approach, called Psychological First Aid addresses the issue of immediacy. Brymer & Company (2006) continue by stating, "You need to have accurate information about what is going to happen, what services are available and where they can be found. This information needs to be gathered as soon as possible [emphasis mine] given that providing such information is often critical to reducing stress and prompting adaptive coping" (p.13)
The Need of Crisis Intervention
There are many scenarios that a crisis counselor might come into contact with. Each one has its own unique attributes. However there are certain factors that remain the same with regard to the evidence of need. In counseling victims of violence, there may be evidences of PTSD (Post Traumatic Stress Disorder). For instance, if a woman has been abused and has repeatedly been stalked, PTSD may be an issue that the counselor should watch for and be alerted to. Sandra Brown (2007) points out that crisis intervention in particular, require that the intervener informs the counselee what to do in the face of imminent danger, stating, "The concept of stalking trauma syndrome has been developed to describe types of PTSD symptomatology (Collins and Wilkas, 2001). A counselor needs to be alert [and aware] to any kind of traumatic emotional evidence that can guide the intervention and short-term goals" (p.54).
Solution-Oriented Brief Therapy
A distinct advantage of the Solution-Oriented approach is that it addresses the issue of immediacy, or the need to provide intervention within a specific effective time-frame, and allows the counselor to immediately focus on the solution and not become reflective on what precipitated the crisis. The difference between being problem focused and solution focused is that one focuses on the root cause in order to alleviate the problem (Cognitive Counseling) while the other focuses squarely on quickly assessing the situation and assisting in creative change and a positive course of action. Kollar (1997) states, "the approach often used today is based on some form of Albert Ellis's rational-emotive therapy (RET) or one of the other cognitive-behavioral approaches" (p. 43). With regard to becoming Solution-Focused, Kollar (1997) states, "As we have seen, a question such as "what is the root problem?" assumes that the answer lies in present patterns that need to be analyzed, understood, and departed from. The question that underlies a solution-focused approach is, "How do we create solutions with the counselee" (p. 44). In this regard, the crisis intervener follows certain core actions that will facilitate successful intervention. These core actions can and should be influenced by underlying assumptions that include conformity to the image of Christ as part of the Christian counseling paradigm (Rom 8:29).
Another advantage of solution focused brief therapy is that it is best suited to time-limited counseling which is inherent in crisis intervention. Benner (2003) observes four common principles that are generally followed in time-sensitive counseling. He states, "All brief, time-limited approaches to counseling share four common principles-- the counselor must be active and directive, the counseling relationship must be a partnership, the counseling must concentrate on one central and specific problem and time limitation must be maintained" (pgs. 48,49).
A third consideration is the natural paradigm shift that occurs when the attention is placed on the solution rather than the problem. Hawkins (2010) states, "People are looking for answers (solutions) in the counseling process. Brief therapy recognizes that the problems people encounter are not just in the person but around the person; Brief therapy is a paradigm shift that focuses the client on the solution, rather than on the problem" (p. 2). This fact is of extreme importance to the crisis counselor. His job is not to de-brief the victim, ask questions about what happened, etc., but instead he needs to shift the focus from the problem/crisis and onto the solution in order to calm the victim and help them to regain control of their coping abilities.
In addition to these considerations, Hawkins (2010) states that brief therapy "is a method that allows you to start immediately into the counseling process [and] accelerate the change process" (pg. 1). For these reasons, solution focused brief therapy is particularly suited to crisis intervention.
Seeing that this research concerns itself with a brief model approach to crisis intervention, the researcher has attempted to further explore the merits of solution-focused therapy. The solution-focused approach to brief therapy has been practiced for some time as is clear in Steve de Shazer's (2007) work More Than Miracles: the state of the art of solution-focused brief therapy, which states, "Solution focused brief therapy (SFBT) is a future-focused, goal-directed approach to brief therapy developed initially by Insoo Kim Berg, Steve de Shazer and their colleagues and clients at the Milwaukee Brief Family Therapy Center in the early 1980's. Developed inductively rather than deductively, SFBT is a highly disciplined, pragmatic approach rather than a theoretical one" (p.1).
There are a number of examples which may serve as a guide to a structured approach to crisis intervention. These interventions have achieved significant results when implemented. Whichever one is adapted, the counselor/intervener should include the four common principles as stated above. One good example is the list of core actions within the Psychological First Aid approach which itself is a compilation of informed approaches designed from empirical research. These core actions include contact and engagement with the counselee, ensuring the safety and comfort of the victim, stabilization (if they are physically or emotionally traumatized), information gathering (with regard to their needs or current concerns), and any kind of practical assistance that can be given. This can be followed by information on coping, connecting the counselee with support groups and linkage with collaborative services (adapted from Brymer & Company, p. 19). These first set of core actions represent one way of developing a structure of solution focused intervention.
A second example of structured intervention and the counselor's task (from a general point of view) includes many of the same components. "This process involves Entry: preparing the counselee and opening the relationship, Clarification: [re]stating the problem or concern and reasons for seeking help, and Formulating: encouraging a hope-filled solution to the problem" (adapted from Brammer, pg. 55). The next task would include facilitating positive action. "This would include exploration: formulating goals, planning strategies, consolidation: exploring alternatives, working through feelings, planning: developing an action plan to resolve conflicts, reduce painful feelings, and consolidating and generalizing new behaviors to continue self-directed activities" (Brammer, 2003, Ibid.).
When the crisis worker enters the world of the counselee, whether that is the scene of an accident or the docile environment of a living room, it is important to gather as much information as possible while rapport is being developed between the counselor and counselee. At this point, the intervener will begin to inspect the circumstances that have presented the crisis in order to quickly identify the causation. The ABC model of intervention has proved valuable in directing the thoughts of the intervener to assessing need. In this "boiling down" process, the worker quickly identifies the precipitating event, seeks to understand the cognitions of the counselee, gages their emotional state, including functional abilities and then moves on to the therapeutic interaction (adapted from the ABC Model of Intervention, Kanel (2007), p.78). The first assessments in intervention prove to be the most critical.
Jeffry Guterman (2006) makes the observation that in most circumstances, people have existing strengths and skills that can be identified and utilized in the crisis counseling engagements. He states, "Solution-focused counseling, like other counseling models, is not value free [it has assumptions]. It operates in keeping with a view of what problems are and what problems are not. Solution-focused counseling holds that people have existing strengths, resources and problem-solving skills---in effect, the natural resources that are needed to solve the problems that bring them to counseling" (p. 3).
Recognizing Inherent Danger
In a more recent publication, Albert R. Roberts (2005) has noted that no two people are the same with regard to the inherent danger they face when trying to cope with crisis. Roberts (2005) states, "When two people experience the same traumatic event, one may cope in a positive way while the other person may experience a crisis state because of inadequate coping skills and a lack of crisis counseling. Two key factors in determining whether or not a person who experiences multiple stressors escalates into a crisis state are the individuals perception of the situation or event and the individual's ability to utilize traditional coping skills" (p. 5). This is illustrative of the fact that the way a person perceives a crisis is very important in the assessment process and can help to guide the counselor in his effort to provide aid. This observation also holds true with the thinking that two of the most important parts of structured intervention are assessing need, and recognizing inherent danger.
Richard K. James (2008) observes, "People can react in any one of three ways to crisis. Under ideal circumstances, many individuals can cope effectively with crisis by themselves and develop strength from the experience. They change and grow in a positive manner and come out of the crisis both stronger and more compassionate. Others appear to survive the crisis but effectively block the hurtful affect from awareness, only to have it haunt them in innumerable ways throughout the rest of their lives. Yet, others break down psychologically at the onset of the crisis and clearly demonstrate that they are incapable of going any further with their lives unless given immediate and intensive assistance" (p. 4). For this reason, and others, it is important that the intervener enters the crisis scenario with the intention of first assessing the need. By doing so, he/she can understand something of the severity of crisis and assess the subject's ability, but more importantly, recognize and understand the inherent danger in the crisis situation.
Suggesting Creative Change
In many instances, such as doing crisis counseling in marriage, an intervener may effectively use solution-oriented brief therapy to suggest creative change that will facilitate healing and bring help to struggling relationships.
With regard to rapid intervention, Michele Weiner-Davis (1992), in her book Divorce busting: a revolutionary and rapid program for staying together, the author explains the following:
"By identifying each person's role in the way the problem is being handled today, brief therapists obtain the raw data necessary to generate prescriptions for change. By so doing, lengthy reviews of personal histories are bypassed. More importantly though, SBT therapists focus on the future, helping couples envision what their lives will be like without the problems. Unlike psychodynamic or psychoanalytic approaches which emphasize how problems develop, SBT asks: "What do you want to become?" and "What are the necessary steps to get there?" Therapy becomes less explanation-oriented and more solution-oriented, a process which takes considerably less time" (p. 16).
This scenario illustrates how that brief therapy can be effective in a crisis situation. It also underscores the concept of rapid intervention in a crisis situation. Assessing need and envisioning (with the counselee) a prescription for change can drastically affect the outcome of the crisis. This emphasizes that creative change, suggested in a timely fashion, during which solution-oriented crisis intervention is employed, can be effective in achieving significant results.
It is important that the counselee joins the counselor in active participation in achieving the solution oriented goals. Kollar (1997) states, "a solution focused counselor, by contrast, will guide but not control the counseling interview by his skillful use of questions" (p.50). It is important that the counselee takes an active role in exploring creative change. It is also important that the responsibility for change is shifted to the counselee. Walter & Peller (1992) state, "The solution-focused model places responsibility on the other side of the relationshipâ€¦clients are the experts on what they want to change, as well as in determining what they want to work on" (p. 28).
Facilitating a Positive Course of Action
Positively reinforcing the intervention through Referrals and/or Follow-up may be required in the case of acute emotional trauma after a crisis situation. In some instances, a lengthier (therapeutic) course of action will be necessary. It would be advisable for the crisis intervener to network with other resources and provide information for follow-up treatment to the victim. In many cases, the solution-based brief therapy model of crisis intervention can be followed up by practitioners who utilize this modality in a more controlled setting and for a more extended encounter.
Some questions may remain with regard to follow-up treatment and the referral process. More and more, professional counselors are taking advantage of the brief therapy model instead of more cognitive treatment but not necessarily because it seems to be the most practical form of intervention as much as that this modality figures into their forced restraints placed upon them by insurance companies. With regard to these restraints, Albert Roberts (1995) states, "In regard to the practice setting, a growing number of therapists and counselors are being forced to use similar theoretical orientations and techniques. The primary reason for this trend toward conformity is increasing limitations placed by health insurance providers on the number of reimbursable sessions per client" (p. 6). While this is hardly a justifiable reason to choose brief therapy, it does serve to illustrate the practicality of the method. Roberts (1995) goes on to say, "therefore, professional counselors are being force not only to be consistent in their treatment modalities but to do their best to resolve their clients problems in the shortest amount of time possible" (p. 6). This seems hardly a sound reason to choose SFBT yet it seems to be more common today. The question remains, does SFBT provide a valid alternative with regard to crisis intervention? This research attempts to prove that a Solution-Focused approach to Crisis Intervention is a valid and productive way to initiate and conduct Crisis Intervention.
Quite often, follow-up is not necessary in crisis intervention but on occasion, the counselor may be required to develop a plan for referral for those who are experiencing long term effects from crisis situations. In this case, resiliency is a factor as well as the general coping skills developed by the counselee. Hamaoka & Company (2007), at the Uniformed Services University of the Health Sciences, observes:
"Many acute negative behavioral and emotional responses remit over time and do not require formal treatment. This tendency toward recovery is often credited to resiliency, a dynamic process of health recovery and coping in the face of adversity. Optimism, intelligence, humor, creativity, and active coping are related to resilience and positive outcomes after crises. Through active coping, individuals accept the impact of traumatic events and implement attainable, concrete measures to improve things.
Although many people experience distress after a crisis, some experience more persistent psychological sequel, such as anxiety, insomnia, increased smoking, increased alcohol consumption, and bereavement. This group may benefit from supportive psychological interventions, including psychological first aid and brief pharmacological interventions for sleep or anxiety. A still smaller group will develop psychiatric illness, including anxiety disorders (acute stress disorder, ASD; and posttraumatic stress disorder, PTSD), major depressive disorder, and substance use disorders. Such individuals require more formal (and perhaps more prolonged) interventions, including psychiatric treatment" (p. 2).
The afore-mentioned quote from Hamaoka & Company (2007) is a sobering reminder that positive, hope-filled, solution-oriented crisis intervention can mean the difference between renewed coping and prolonged damage. As a crisis intervener, it is imperative to choose the most effective modality or paradigm in which to conduct care.
This research points out the value of solution-focused brief therapy as a model in the approach to crisis intervention. It may be adequately utilized in a number of scenarios and as research has concluded, can serve to be as effective as more long-term therapy. Because of the nature and the needs of crisis situations the intervener can practically use the principles of solution-focused brief therapy as a crises intervention. By using this modality, the intervener can approach the initial encounter in a structured way, assess the needs and recognize the inherent dangers both to himself and in particular to the counselee.
The intervener may then suggest creative change to facilitate a positive course of action as a part of the intervention. After the initial encounter, positive reinforcement of the interaction as well as the further development of coping skills may be achieved through referral or active follow-up.
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