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Crisis situations are situations of high risk. In a crisis, something is happening or has happened to abruptly change the participant’s perception of a safe and ordered world. It is as though the bottom brick in a column of bricks is being pulled away so that the whole column will collapse. However, there is another and very different perspective on the appraisal of a crisis which we will consider later under the heading ‘The dangers and value of a crisis’. Can you think what it might be? Firstly, however, let’s think about the various types of crises that people typically experience.

There are several very different types of crisis. Although they are different, they also have similarities. They all raise the stress level of the person or people involved and call for a quick response in order to minimise practical, emotional and psychological damage. You may wish to stop reading for a moment or two to see whether you can identify for yourself the different types of crises that people experience.

We are all familiar with crises which fall into the following categories:

• Natural disaster
• Accidental
• Medical
• Emotional
• Relationship
• Developmental.

These categories are not mutually exclusive or independent of each other, but are useful in helping us to think about the similarities and differences of various types of crisis. We will now consider each of the categories listed.

Natural Disaster

TV news has made us all very familiar with the practical type of crisis with physical and emo-tional consequences that occur when a volcano erupts, there is a bushfire, a flood or an earth-quake, or when lightning strikes. Sometimes the effects of natural disasters are long-lasting. A drought can cause famine, and the effects may last for years unless there is an effective and timely response. Unfortunately, as with most crises, natural disasters usually occur with little or no warning.

Accidental Crises

These crises inevitably occur from time to time. Examples are when a building catches fire, when two cars collide or when a child falls down some stairs. In the worst accidental crises there is a loss of life.

Obviously, these crises occur without warning, with the consequence that those involved are not properly prepared and are often not able to make the most appropriate response.

Medical Crises

Some medical crises fall into the ‘accidental’ category. However, many do not. Medical crises occur when people have strokes, heart attacks, seizures, asthma attacks or any of the many medical conditions that of the human race. Similarly, medical crises occur when people are incapacitated by illness. A migraine headache, for example, may prevent a person from doing those things necessary for their own wellbeing and the wellbeing of others.

Other examples of medical crises are when a woman delivers a baby unexpectedly and there is no one around to help, or when there are complications with a birth. Similarly, a crisis occurs when a baby becomes sick or when there are problems with feeding a baby.

Medical crises are often very frightening be-cause of high personal involvement at a physical, emotional and psychological level. As with accidental crises, in the most severe cases there can be loss of life.

Emotional Crises

An important and valuable human characteristic is our capacity to be emotional. If we were deprived of our emotions we would be automatons – mere machines. Unfortunately, at times the emotions we experience are painfully destructive and prevent us from functioning normally. Rage, sadness, depression and despair can all lead to states of crisis where the individual may be at risk.

Relationship Crises

Anyone who has worked for a telephone crisis-counselling service will tell you that relation-ships are a common factor underlying many crisis calls. Dysfunctional relationships, broken or lost relationships, and the absence of relation-ships are probably the most common causes of emotional crisis. However, we are separating relationship crises from other more general emotional crises because this is such an important subcategory.

Time and again people experience crisis when relationships are strained, break up or are lost through death or unavoidable separation. Often, spouses feel devastated and as though their whole world has collapsed when they discover that their partner is having an extramarital affair. Sim-ilarly, those involved in having an affair usually experience a high degree of emotional pain.

Sometimes people experience profound disappointment due to the behaviour of those who are in close relationships with them. Parents are particularly vulnerable to such feelings. Time and again, parents have told us how disappoint-ed and sometimes devastated they were when they learnt that their child had been caught stealing or behaving in some other way contrary to their own expectations.

Unfortunately, too often in our present society relationship crises involve physical violence, usually with women and children as the victims. Counsellors are continually hearing about emotional, sexual and physical abuse occurring within families, which should provide a safe and secure environment.

Developmental Crises

There are some crises that none of us escape. These are the developmental crises that occur naturally and inevitably as we pass through the various developmental stages of our lives.

For most people the first developmental crisis is probably at the time of birth. However, for some there could well be earlier ones when, for example, sudden changes occur within a mother’s body. From birth onwards the list of developmental crisis times is endless. Here are a few examples:

• When a child takes a first step
• The first day in child care
• Starting school
• The onset of puberty
• Starting work
• Leaving home living with a partner
• Getting married having a child
• Death in the family separation mid-life crisis
• Divorce
• Starting again with a new partner
• Retiring
• Growing old
• Dying.

At each of these stages there is risk involved, a raised stress and anxiety level is inevitable, and there will probably be other emotional responses. Often, there is a need for appropriate decisions to be made with consequent action. There is an inevitability about many develop-mental crises. They are often a natural and necessary part of growing up and getting older. However, each crisis can be threatening, calls for a response, and marks the beginning of a new stage in life.

Most crises spell danger. They are fraught with risk. They shake us up and interrupt the com-fort of our lives. They call for responsive action and usually this needs to happen without delay. However, crises are not necessarily bad. Al-though they usually do have emotional consequences, there is another way of looking at crises. A time of crisis may also be a time of opportunity. The impact of a crisis often produces an opportunity for change. A crisis can be the catalyst for the development of something new. It can be a time when we let go of what has been and start afresh.

Surprisingly, even from the most terrible tragedies something of value may emerge. Saying this in no way diminishes the sadness and horror of tragedy, but it is worth remembering that, given an appropriate response, something new and worthwhile may grow out of a tragedy. A person may grow stronger psychologically or spiritually, relationships may change for the better, or something in poor condition and of limited use may be replaced with something more useful. Unfortunately, though, many people are permanently scarred by the crises that they have experienced.

A good metaphor for a crisis, which can some-times be used when counselling, is to describe the crisis experience as rather like going through a doorway from one room into another. If you imagine yourself moving through a doorway between two rooms, you may recognise that you are leaving behind many of the things in the room you are departing, although you may be taking some things with you. In the new room there will be some unknowns. Consequently, you may experience sadness at losing the things you are leaving behind. Also, you may experience apprehension as you wonder about what lies ahead in the new room. If you wish, you can focus on feelings of apprehendsion and this may be threatening. Alternatively, you may be able to give yourself some positive messages about the future so that you feel challenged and consequently energised.

In using this metaphor we need to remember that it is usually not appropriate to tell someone in crisis that something good might emerge! To do such a thing would usually be inappropriate and would not address the person’s pain. However, as the person is starting to move out of a crisis, it may be appropriate to use the metaphor. At this stage positive opportunities may present themselves, so that at the appropriate time these may be fully explored with the person seeking help.

It is also useful to remember that in some instances it may be premature and inadvisable for a person to make far-reaching decisions before they have had time to work through the trauma of a crisis. However, the converse can also be true. Sometimes, a crisis provides the opportunity and impetus for sensible and important decisions to be made.

What’s appropriate at a counselling level will clearly depend very much on the nature of the crisis, and whether the counselling is face-to-face or by phone. For example, if a house is on fire and the person doesn’t know what to do, then it will not be appropriate to spend time reflecting feelings. Practical advice is urgently required! Give it.

Yes, we counsellors generally try to avoid giving advice and instead encourage those who seek our help to make their own decisions. However, as with most rules, common sense is needed regarding when to apply the rule and when to do the opposite. Sometimes when quick action is needed, we have to be very direct in order to prevent a major disaster from occurring. Quick action does not mean acting in panic but means being carefully decisive and giving clear instructions.

If as a counsellor you find yourself panicking, once you become aware of this, take action to deal with the panic. Then sensible decisions can be made with regard to the most satisfactory approach.

Similarly, if a person seeking help is panicking they will be unlikely to respond effectively and act sensibly. The counsellor’s first job in this situation may be to help the person to deal with the panic. A possible counselling response in this situation could be:

What do you think of this response? It joins with the person, may enable them to recognise and deal with the panic and addresses the need for action. It could be an appropriate response, depending on the situation. Can you suggest some other suitable responses?

Throughout a crisis intervention, try to maintain as much calmness as you can so that the person seeking help is reassured. If you are able to do this they will feel more secure and will be more likely to believe that a satisfactory out-come will be achieved. They might then be able to match some of your calmness.

As a crisis intervention proceeds, the full range of counselling skills are often required. If you stay with the person, using the normal process of a counselling session as outlined in Chapter 16, then they will feel supported and empowered to cope. They will be enabled to experience their feelings in the safety of the counselling relationship and should reach some sense of completeness by the end of the process. Yes, you may leave them feeling intensely sad, drain-ed and possibly even devastated, but hopefully you will have managed to create a relationship of trust so that they felt supported through the crisis. If you did, then the person is likely to feel comfortable in coming back to talk with you, or with another counsellor, in the following few days or weeks. It is during this time that they may well need counselling help as they cope with the emotional, psychological and practical after-effects of the crisis.

Although all the micro-skills are needed, it is worth remembering that the micro-skill called ‘normalising’ (see Chapter 17) is particularly useful when dealing with developmental crises. People often feel relieved to know that what is happening to them is inevitable and normal, even if distressing and painful.

Sensibly, the counselling interventions used must take account of any practical options available to the person concerned and the counsellor, so we will now consider practical responses to a crisis.

It is essential that counsellors involved in crisis intervention are clear about the range of prac-tical responses available to them. Because crises usually come without warning. counsellors need to be prepared. As a counsellor you need to know what options you may have when confronted with a person who is in a crisis situation. You need to have a clear idea of the boundaries within which you work so that you know what you can and can’t do. The options available to you and the boundaries that constrain you will depend on the policies and practices of the agency where you are working.

• You, the counsellor, will need to know the answer to a number of questions including the following so that you can be of help to a person in an emergency situation:
• If a person phones you in a crisis, are you able to go out to visit them or not? If not, is there someone else on your counselling team who is able to go? If so, what limitations do they have to their ability to intervene practically?
• Are you permitted. within the guidelines of your employing agency, to ask a person in a crisis to come in to see you, or to see another counsellor? Under what circumstances can this be done?
• Can you supply or arrange for transport, accommodation, financial or material assist-ance or any other service for the person seeking help?
• Does your agency’s policy allow you to accompany the person seeking help to give them practical assistance?
• Do you have a comprehensive list of resources available, so that if you can’t provide the required help yourself, you can let the per-son seeking help know who might be able to help?
• Are you permitted to call the police, an ambulance, the fire brigade or any other service? If so, do you need to have the per-son’s permission in all cases or are there exceptions?
• Can you arrange for women and children subject to domestic violence to be accommodated in refuges, or in other temporary accommodation if refuge accommodation is not available? If so, who will supply the transport? Will someone from your agency or another agency be available to accompany the person/s or not?

Clearly, these are just some of the questions you may need to answer and there are countless more. Unfortunately, you probably won’t think of some of them until a specific situation arises that is new to you. In training, it’s useful to brainstorm and to try to think of every imaginable crisis so that you know exactly what is available, and exactly what you are, and are not. permitted and able to do.

Expectations of the Person Seeking Help

People seeking help sometimes have unrealistic expectations of counselling services. This is particularly so in the case of crisis telephone counselling services, where some callers may expect that counsellors are at all times available to visit those who would like such a visit. From the outset it can be advantageous to be clear with the person seeking help about the limits of your service so that false or unrealistic expectations do not develop. Can you say ‘No’? It’s hard to say ‘No’, isn’t it? For example, you may need to say to someone who is seeking help, ‘I’m sorry, but there is no one available to see you right now, but you are welcome to talk with me on the phone if you would like to do that.’

Practical Intervention

At an appropriate stage in the counselling pro-cess you, the counsellor, may need to assess whether there is a need for practical intervention. For example, it might be advisable to call an ambulance, the police, the fire brigade, a medical practitioner or some other helper. Alternatively, for example, in a case of threatened suicide, it may be necessary to arrange for a crisis worker to meet urgently with the person who is making this threat.

In many agencies, counsellors work under direct supervision. If you work in such an agency, then you may need to inform or get permission front your supervisor before being able to set in train an appropriate practical intervention. While doing this it is important to stay in touch with the person seeking help as much as is possible. A person who phones in a crisis situation is likely to feel anxious if left on hold for even a short time. Be careful to maintain as much continuity of contact with them as possible and to keep them fully informed of your actions. In particular, if you are putting a caller on hold tell the caller why you are doing that and let them know how long your absence is likely to be. If you take longer than expected, interrupt what you are doing, go back quickly to the phone and reassure the caller.

Be cautious when considering whether it is necessary or not to intervene at a practical level. It is often tempting for a counsellor to take over responsibility from a person when this is not really necessary; sometimes intervention by a counsellor is very appropriate but at other times it is not.

Consider an example where a person needs an ambulance. In some cases, it may be advantageous for the person, and not the counsellor, to call the ambulance. By doing this the ambulance personnel get a direct message from the person involved rather than a message that might have been inadvertently altered in transmission. Also, it is empowering for a person to take action rather than to be left feeling that they are incapable of doing so. On the other hand, in some cases there may be uncertainty about the ability of the person concerned to perform the task satisfactorily, or they may be particularly vulnerable and in need of support. In such cases, the counsellor may sensibly decide, with the person’s permission, to call the ambulance on their behalf. Clearly, sensitive judgement is needed by counsellors in deciding when to intervene and when to encourage a person to take responsibility themselves for any necessary action. There can be no hard and fast rule.

Giving Specific Instructions

At a time of crisis intervention a counsellor may need to be very directive and very direct in order to avoid an escalation of the crisis. This is particularly so in cases where the counsellor has professional knowledge that will be useful to the person involved. If we use childbirth as an example, a nursing sister, medical practitioner, paramedic or other trained person may be able to provide crucial information that can be essential for the wellbeing of the mother and child. Such a person needs to be clear, concise, concrete and specific in giving directions to the person seeking help or helpers. Even so, it is imperative that the counsellor retains the full use of listening and joining skills. It is at times like these that the person undergoing the crisis may have important information to give that could be overlooked unless full attention is given to their verbal and non-verbal communication.

As in counselling generally, it’s desirable to stay in tune with the feelings of the person seeking help, so that any intervention initiated is acceptable to them. Exceptions to this are situations where the counsellor needs to intervene in order to fulfil their duty of care to the person seeking help or to other people involved. Clearly, counsellors have a duty of care in cases where a person is out of control of their own behaviour due to psychosis or drugs, or in cases where the safety of another person is at risk.

Unfortunately, a counsellor’s work does not necessarily finish when a crisis is over. It is now well documented that people often suffer from emotional and psychological after-effects as a result of a severe crisis. These after-effects are generally referred to as post-traumatic stress.

Post-traumatic stress can occur in persons who directly experience a crisis, and in people who act as helpers at a time of crisis, such as emergency services personnel, police, ambulance personnel, medical and nursing staff, counsellors and social workers. Relatives and friends may also suffer post-traumatic effects.

Usually the first evidence of emotional trauma becomes apparent immediately after the crisis, or within a few days. Some people try to shrug off these post-traumatic effects, believing that time will heal all. Unfortunately, time often doesn’t heal all, and it is common for those who have been personally involved in a crisis, and those who have in some way helped them, to be seriously affected emotionally and psycho-logically some weeks or months after the event. Post-traumatic stress can best be minimised by those involved undergoing counselling at a time of their own choosing – some people who have experienced a crisis will prefer to engage in counselling shortly after the crisis event, whereas others will prefer to defer counselling until later.

Because of the possibility of post-traumatic stress, it is sensible to follow up on people who have been through a severe crisis. During the days and weeks following a crisis it can be advantageous if the people involved are offered counselling help. Without this offer, the risk of undesirable psychological effects showing up later may be increased.

As stated previously, counsellors may be affected themselves when they work with people who are experiencing a crisis. As a counsellor, don’t forget your own needs. After counselling someone in a crisis, talk to your supervisor or another counsellor about your own experience of the counselling process and the emotional feelings generated within you. Such talking through, or debriefing, as it is called, needs to be accepted as necessary and normal after any crisis intervention work. It certainly is not a sign of weakness to engage in such debriefing. On the contrary, it is a sign of maturity, good sense and personal strength.

• Crisis spells danger and opportunity.
• Crises occur naturally, accidentally, medically, developmentally, as a result of emotional and relationship problems, and in other ways.
• In crisis intervention, counsellors need to deal with panic, be calm, use the full range of counselling skills and sometimes give specific directions to the person seeking help.
• Counsellors need to know the limits of their ability to intervene practically. They need to be clear in communicating these limits to those who seek their help.
• Counsellors need to be prepared for crisis and to have ready access to information about available resources for practical help.
• There are times when it is appropriate to intervene practically on a person’s behalf, and times when it is not.

Appropriate action is required to deal with the possibility of post-traumatic stress in both the person involved and the counsellor.