Clear crisis focus leads to a clear definition of the crisis.  If we can confidently answer the four focus questions, then we can define the crisis.  We know what the crisis is, what is wrong, how bad it may get, who is affected, and why our intervention is required.  As we will see, knowing these things gives us a firm foundation for the development of our intervention strategy.

Mrs. F calls the hot line.  She is crying and seems somewhat desperate.  She had called the hot line a few minutes earlier but had hung up rather abruptly.  You tell her that you are glad she called back; you had been worried about her.  I was telling you about my son.  He is still not going to school.  Just doesn’t pay any attention to me.  I have told him and told him that he is going to get into trouble.  Just won’t listen.  Kids these days think they know it all and won’t pay attention to anyone.  He may be involved in drugs.  I know he’s running around with a no-good bunch.  They already have been into it with the police.  [You ask: What happened?]  Two or three of them stole a car and went for a joy ride.  The police finally stopped them, but no charges were filed.  He keeps doing it and getting off.  I hope it catches up with him one of these days.  I finally talked to an attorney about it and decided to have him brought to juvenile court.  My family thinks I’m terrible.  They think I’m wrong.  They think I don’t love him.  ‘How could I do that to him if I really love him?’  They just don’t know.  They don’t have to live with him.  He just comes and goes as he pleases.  He’s never home unless I have company.  Then he’s always around acting smart and showing off.  He always messes things up for me.  I don’t know.  Maybe if I had stayed with his dad, he could have handled him.  I sure can’t.  [You ask: Are you and his father divorced?]  About ten years now.  I can’t be mother and father both.  I tried, but the bills and the house and everything are just too much.  I have been dating a very nice man, and I’m afraid he’ll quit coming around because of the way my son acts.  I think I have a right to some happiness, too, and my son just keeps messing things up for me. …

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Thus far, we have located the conflict within the interaction between the individual and his total situation.  We have determined that it has a high now potential and a low self-resolution factor, justifying our intervention.  We have asked, What happened, and are developing an understanding of the precipitating event.  Our picture of the crisis is taking on form and content.  We are ready to consider the assessment set.  From this point on, crisis intervention is unlike more traditional forms of counseling and therapy.  Traditionally, we want to know as much as possible about the person; his total situation; his now, then, and when; and as many other related factors, situations, conditions, circumstances, and events that possibly concern the individual and his situation now.  Our picture needs to be as complete and as detailed as possible.  To achieve this level of understanding requires long-term interaction between therapist and patient as well as a high level of skill and training on the part of the therapist.

In crisis intervention, our focus is considerably more narrow, centering sharply and clearly on the crisis itself.  This point can hardly be overemphasized, and as a test of crisis focus, we should always consider these questions.

Specifically, what is likely to get worse? …

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Crises are not always what they seem to be.  For example, Michelle is in what might be considered a suicidal crisis, that is, she might kill herself if something is not done.  To the casual observer, it may seem that the possible suicide is the crisis.  Of course, Michelle’s killing herself is the potential of the crisis.  But it is not the crisis itself.  The crisis exists in the temporary and serious interaction problem between Michelle and her situation.

Wanda’s anger is almost rage like.  That bastard—my husband—can’t think that he can treat me that way and that I’ll just sit around and do nothing.  He’ll find out that I’m not just that quiet little mouse he thinks he married.  I’m going to do it this time.  I won’t stand for it.  He can’t do that and get away with it.

What did Wanda’s husband do?  What is she going to do?  From her initial angry comments, we are unable to answer either question.  Nonetheless, considering how angry she is, we get a sense that her actions may not work out very well.  Within those actions lies the now potential of the crisis.  Whatever her husband did seems to have precipitated the crisis.  We can see then, that Wanda is between the precipitating event and acting out the now potential.  For her though, the crisis is now.  Her present interaction (with you) is the first focal point.  Your assessment of her crisis will expand to include both the precipitating event and the now potential.  You will look at possible causes and possible cumulative effects.  Gradually, you can develop a picture of her crisis in a careful and caring way.  Nonetheless, starting where Wanda is now and expanding your understanding from there allows you to assess her crisis effectively, gives emphasis to your now relationship with her, avoids the possibility of oversimplifying the crisis, on the one hand, or seeing it as more complex than it really is, on the other.  You can help Wanda both understand and deal with her crisis as it really is.

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To say that an individual is in a crisis state, we must first be aware of a conflict between the individual and his total situation.  Next, we must judge the conflict to hold high now potential.  Finally, we must judge the conflict to have a low self-resolution factor.  If these conditions are met, we have a crisis requiring our intervention.  To conceptualize, a crisis state exists when a conflict holds immediate potential for significant deterioration in the person or in the situation, combined with a low probability of either the person or other individuals in the interaction being able to resolve the conflict.

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Do we have a right to intervene?  If the situation really is a crisis (has high now potential and low self-resolution factor), we not only have a right to intervene but we also have a responsibility to intervene.  This responsibility is based on our mutual responsibility and a very human interest in one another.  A value framework underlying human services and crisis intervention specifically directs us to do what is reasonable and necessary for the well-being and welfare of people receiving our help.  The parallel with the Good Samaritan is clear.

Will the individual in crisis get angry with us, accuse us of meddling, tell us to leave him alone?  Perhaps.  Will our efforts be appreciated?  Will people see that we are making a sincere effort to help them?  Perhaps not.  The question for us is, When the ‘now potential’ is high and the self-resolution factor is low, do we, at a feeling/valuing level, have any real choice other than to do what we can to help?  Of course, if someone might die or if something else terrible might happen, we will try to help.  If the individual or someone close to him has asked, we will help.  At other times, our intervention will be required by virtue of our job or position.  Will you take a chance?  There are personal, emotional, and interpersonal risks, and our willingness to take such risks is an important part of what we bring to crisis intervention.  Professional counselors and psychotherapists know about the balancing act between over involvement and under-involvement.  As a volunteer, student, or other newcomer to crisis intervention, you will need to develop a feel for and an understanding of the risks for yourself.  Not to take the risk though, many times means pulling back from the opportunity to help.  Whatever the situation or circumstance, when a real crisis exists we will intervene, knowing that it is usually better to do too much than too little.

Our intervention should be directed by three specific considerations.  First, is our intervention reasonable?  Based on our knowledge and understanding of crisis intervention and people in crisis, does the present situation really have a high now potential and a low self-resolution factor?  A different kind of crisis may illustrate the point. …

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Once we have determined the now potential of the crisis, we want to judge whether or not our intervention is necessary.  We may think that the individual can handle the situation himself.  But if our faith in his ability to deal with things lacks enthusiasm, we may decide that someone else in his total situation has the knowledge, skill, and capacity to deal adequately with it.  In other situations, we may conclude that the crisis has already passed its most serious stage and that the situation and the people in it will be able to work things out satisfactorily without our help.  In any of these cases, our judgment tells us the crisis will be satisfactorily resolved without our intervention.  In short, we judge the self-resolution factor of the crisis to be high.

If, instead, we think that the situation will worsen or that the crisis will not be resolved unless someone does something, we would conclude that the self-resolution factor is low.  It is in such situations that our intervention is required.

In the cases discussed thus far, the self-resolution factor has been fairly low.  The people in crisis seem to be temporarily unable to cope with their feelings or life situations.  From the information we have about these cases, there appeared to be no one in the individual’s situation who could deal adequately with the crisis or who was in a position to help the individual deal with it.  They had contacted us during their crises because their confusion, depression, loneliness, or anger interfered with their ability to handle their present situation.  Sometimes though, we will learn through discussions with individuals in crisis that there are other people in their situations who can help them.  For example, we may find that the individual has a good and continuing relationship with his minister.  We may want to encourage such a person to call the minister for help with this particular crisis.  In other situations, we may find that a child has brought a serious problem to us but has not discussed it with his parents.  We may learn that he has a good relationship with his mother and father and that they are interested in him and usually have no difficulty in communicating with him.  We are just the first person who happened along.  We might suggest to the child that he talk about it with his parents or that we give them a call and ask them to help him with his problem.  In this kind of situation, the child is frequently quite willing to discuss the problem with his parents and has real confidence in his parents’ ability to handle the situation.  At other times, an individual may contact us about a situation with which the family doctor is familiar.  It may be that he has been working with his doctor on the problem.  If he has confidence in the doctor, we should assume that the doctor has the skills and knowledge necessary to help the individual through this crisis.  In all of these situations, we learn that there is someone else already in the situation with sufficient knowledge and skills to deal with the crisis.  When this happens, we should calmly and politely refrain from becoming involved, encouraging the individual to rely on those people for help. …

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In considering the now potential in crisis, emphasis is first given to the potential, which refers to what might or could happen.  What is the worst possible outcome of the crisis?  Could the individual or someone else in his total situation die?  Could someone get hurt?  Could there be some other similarly serious consequence?  Could the individual’s situation become so deteriorated or so permanently messed up that no amount of help or concern could return it to its pre-crisis state?  The potential of the crisis lies somewhere between no bad consequences or effects and the serious injury or death of someone in the total situation.

The now in the now potential refers to the immediacy or emergency quality of the crisis.  We need to know how quickly things might deteriorate or get worse.  How quickly might the potential be actualized?  Will it take a week, a few days, a few hours, or could the worst possible outcome occur almost immediately?  This how soon is the now in the now potential.  As we intervene into crises by trying to find out what happened and by developing a picture of the individual, his total situation, and the interaction between the two, we simultaneously need to consider and develop a judgment about the now potential of the crisis.  How bad could it get?  How soon? …

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In Figure 3, the individual has shifted from the conflict state to the crisis state.  What happened?  Either suddenly or gradually a new conflict within his interaction developed or an already existing conflict worsened.  We will call the causes of such a crisis state the precipitating event.  Whatever happened, an existing conflict worsened or a serious new conflict developed.  We will say that the precipitating event set off or caused the crisis.  When we are dealing with people in crisis then, one of our first questions will be: What happened?  Our effort here is to move gradually toward crisis reduction.

When seeking precipitating events, the tendency is to look for complex psychological or social causes.  This leads to very complicated notions of cause and to considering factors, situations, conditions, and circumstances substantially removed in time from the crisis.  In the social interaction model, emphasis is place on a precipitating event immediately preceding the present crisis.  The individual in crisis is a complex human being; his total situation is similarly complex.  Moreover, the conflict between the individual and his situation may be complex.  However, the precipitating event tends to have the quality of the straw that broke the camel’s back.  Something relatively definable brought the interaction to a crisis point. …

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Initially, it may be difficult to make the conceptual transition from conflict to crisis.  If so, the difficulty probably lies in a tendency to think about crisis and then trying to understand the crisis state.  If someone is extremely upset, angry, or depressed, we are first aware of the intensity of his emotional state.  In late chapters, we will talk about crisis communication, and we will see that crisis intervention responds first to these intense emotions.  Nonetheless, our ability to help the individual in crisis depends on our sensitivity to and awareness of crisis itself.  Just as conflict exists within the interaction between the individual and his situation, crisis is also a product of that same interaction.  The individual is in crisis; the crisis is not in the individual.  He is caught up in the crisis state.  What is the crisis state?  It is nothing more or less than a limited and special instance of the conflict state.  As we will see, the interaction between the individual and his total situation has become so conflicted that it has temporarily gotten out of hand.  Why did the conflict get out of hand?  What happened that intervention is now required?

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Conflict lies at the interface between the individual and his total situation, is objectively or subjectively perceived by the individual or someone in his total situation, and is causally a function of the individual and/or his situation.

Experience suggests that non-mental health professionals and volunteers tend to perceive the individual in crisis as sick and are thus oriented to a medical model, that is, have a tendency to think in terms of diagnosis and treatment of the problem as if it were something totally within the individual himself.  Reorientation to the social interaction model requires careful attention to and emphasis on locating and dealing with the problem or conflict as a function of the interaction between the individual and his situation.  This reorientation also encourages moving away from a tendency to place blame and to identify individual pathology, and toward intervention based on an interactional understanding, thereby working with the strengths and capacities within both individuals and situations.

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