Crisis Intervention: A Psychodynamic View

• This paper presents a psychodynamic view of crisis

Importance of Crisis Intervention (CI)

• CI significance was widely recognized from Lindemann's work in 1944
• The conception is historically linked to trauma/catastrophe occurrence
• An external factor of relative magnitude is considered as a determinant of the crisis state
• Sees crisis as a response induced by external situations
• Disasters like fires can be experienced by many
• Urban violence, such as kidnapping, can greatly impact individuals
• Trauma can be personal/social, this perspective acknowledges life events’ impact on most people
• Thus, CI has progressively consolidated as a response to emergencies (Roberts, 2005)
• It highlights a rupture period with painful emotional reactions
• Decreased cognitive and functional capacity
• Adaptive and strategic behaviors, the emergence of symptoms (Aguiar, 1998; Sá, Werlang, Paranhos, 2008)
• Traditional psychiatric views utilize this, focusing on dysfunction and symptoms
• Neglects historical/contextual factors
• Treats dysfunction/symptom emergence as "endogenous"
• Prioritizes medicalization in treatment (Sadock & Sadock, 2007)

Crisis Concept in the 1980s-90s

• Was promoted with brief psychotherapy advancements
• Applies to stable individuals whose crisis was triggered by subjective issues/life events (Sifneos, 1993)
• Presumes the capacity to cope with daily situations
• Absence of morbid personality traits
• Therapy focuses on the current situation where symptoms emerge from without an analysis on the crisis's evolutive processes

Caplan & Erikson

• Focus on Caplan (1980) & Erikson's (1976, 1987, 1998) concepts to present and discuss a consistent concept of crisis
• This is with a comprehension of its experience needed for Crisis Intervention work for individuals with structural commitment
• Individuals in severe psychic distress, in risk situations
• These authors recognized the impact of traumatic events, emphasizing evolutive, processual, and psychosocial aspects in a person
• Caplan (1980) defined phases: onset, exacerbation, resolution
• Erikson (1987) placed crisis at the center of personality development/identity consolidation, spanning from birth to old age
• Crisis became viewed as normative and necessary in a psychosocial development
• Linked to task completion of development and skills acquired through experience

Current Exploration

• Aims to presents a expanded view of the process, including psychodynamic development aspects that contribute to;
  • Vulnerabilities in personality leading to personality disorders (McWilliams, 2011; Stolorow & Lachmann, 1983)
• This concept is also influenced by a vision that is;
  • Psychosocial, systemic (Bowen, 1981; Framo, 1970, 1981; Pittman, DeYoung, Flomenhaft, Kaplan, & Langsley, 1981)
• This integrated view is fundamental in the;
  • Reception, evaluation, intervention planning with people with structural vulnerabilities & severe psychic suffering
  • Comprehension of the process, crisis, risk behaviors, and overcoming them

Psychological Crisis: Defined

• Is a subjective process, determined by context/life history
• Experiencing situations in which internal/external reality conditions mobilize someone
• Demands new responses for what an individual has lost access to, not yet acquired/developed, or lacks the repertoire of resources to solve a complex task

Definition Elements

• Demand (mobilizing)
• Internal/external reality conditions
• Response
• Resources
• Complexity (historical/contextually determined)
• Process
• Subjectivity
• Solution

Demand

• Essential term that refers to a condition crucial in the necessity to develop through a crisis
• If there is no requirement that a subject is imposed to, the individual remains in unaltered adaption
• Conditions which this person is exposed to, he will see as satisfactory
• Therefore, where there is no demand, there is no crisis
• A potential characteristc of demand/requirements, is to create tension, disturbance, change that maintains the subject mobilized
• The demand is revealed by the mobilizing situation/context
• It can be paradoxical that apparent demobilization in the face of critical demand, is defensive against anxiety from a situation
• It can cause a limited/false non-crisis perception. For this reason defining crisis as disorganization & apparent suffering can mislead.

Internal and External Conditions

• Internal and external forces impact on an organism continuously
• The organism can organize forces allowing to maintain/reestablish a determined adaptation state for ideal optimized functioning
• Internal and external reality conditions, its action is the 2nd characteristic of demand triggering the Crisis
• Internal and external crisis are caused by interrelated internal/external determinants
• Distinguishing both crisis types supports understanding of it's factors
• This allows strategic intervention definition and differentiated prevention,directed to the subject in the enviroment
• Biopsychosocial trinomial of biological factors in crisis's, is the reality and essence of experience, with interpreted senses, shared family/social
• Meaningful interventions(interpreting, enviorment modifications) can modify these interpreted and shared senses
• The social, relational influences and all environmental interactions with the subject influence demand that includes aspects
• A subject's responses towards demand in turn affect the enviromental outcome reactions or interactions created for support, challenges
• Even a perceived biological crisis stage of development (Such as Learning to Walk) involves internal interactions related to the psychomotor skills
• There is a subjective awareness of the need for new desires and skills
• Demands are also present externally, with promotion of support, and the requirement for early autonomy (can stimulate the psyche if capable)
• May restrict desires, and new skills

Multiple Factors

• Co-alignment often creates a complex network of tensions and conflict, internallly and externally
• Biopsychosocial aspects becomes most expressed and dramatic in adolescence, with constant complexity over maturity
• Aspects from both will set the configuration for crisis installation, and the possibilities of resolution

Response or Reaction

• It is a component derivitive of demand. Mobilizaiton via demand, urges demand of involvement
• Subject involvement will require a reaction or response. Solving cannot only be achieved from environmental factors
• Demands require subject involvement, to achieve a mobilization state. Subjects reactions can prevent crisiss
• Reactions are more broad, applying to a subject, organization, representation, and self
• Including reactions of Affection, Sympathy or Symptoms
• Responses are more limited in term, relating to an action directed (though not consciously) by a subjects ego
• This will be used for developing structuring/adaption, such as defense mechanisms, even during signals the ego is being disorganized
• Creating tension via the subjects' mobilization, influences behavior, encouraging resolution or creating failure signals
• Intervention in a changing crisis, external factors modifying environment influence demand, and removing stressors reduce responses
• Transforming meaning associated subjectively with an demand can have similar effect
• A set demand must have a response, even in omission, or refusal
• Solving an unwanted autonomy by dependance, or unwanted promotion, and stagnation can be a a result, but relieve the anguish that mobilized

Mobilization

• Mobilization occurs from demand, into a subjects responses such as;
  • Demobilization, denial, avoidance, emotional isolation
• The subject must be conscious, and elaborate anxiety factors mobilizing crisis, subjective sense of relief contibutes to the rejection
• Though these mechanisms help impact, their systematic use can result in compromised/partial solutions
• This state requires that the demands and anxieties are unconscious over time, so adjustment is maintained, without autonomy or freedom
• Thus there is a "Trade-off" of benefits for a payment from a compromise solution
• Crises mobilizes and demands the attention it requires

Celia's example regarding assuming the role as substitute

• Solicitation to be appointed in a a role caused similar issues as what did obligating her to accept previously"
• Throughout the process, the difficulty saying "no" was that from a continuous need to seek support from all"
• Sense of satisfaction was of most importance to being promoted from efficient in her job
• Becoming a manager of conflict at her new position , meant taking on decisions and limits
• The tension led to conflicts she was never able to resolve and bring to a head
• Exacerbation increased emotion and induced grave depression, fear, self blame etc, related to rejection, never elaborated or recognized

Crises and Solutions

• Subject-level or objective responses
• Internal or external resources
• This depends on an objective/subjective assessment

Nature and Quality

• Definition and quality of response not dependant, as subject demands the ability to seek them from new differing responses
• Subject responses are incapable of always delivering in every situation
• We also do not include in the definitions of subjective failure towards relevant sitautions, or overcoming these
• We do not base the quality of the responses on not defining on if there is a process in crisis
• Both investment and experimentation in omission, failure, with paralysis/impasse, means a form of response towards crisis
• People in crisis usually intensity previous methods of responding until they fail in subjective view
• Aggressive people relieve tension through substance abuse risk turning violent without understanding how they are influencing the escalation
• If this opposes values, tendency will lead to more adequate responsive strategies

Appropriate Strategy

• Facilitating changes are propreitious and ego-systonic transformation towards ego-dystonic responses
• Lack of ability to find solution towards for an unescapable solution, leads to an response for possible outcome for that subject
• There is no point wanting positive output, even when appears easy and obvious without supporting those to do it
• A seemingly viable suggestion cannot be realized sem understanding complex responses

Resources

• Not all demands are a crisis
• Only demands to have no ability to learn, obtain, no needed repetoire, condition access or loss to the ability to face
• Resources are seen with comprehensive skill/abilities, as a person can have access to interpersonal and social means
• Personal significant reach to persons, through networks form social support, are important to quality of life
• The necessity to recover or develop means to reach external, and internal ressources are the 4th level
• A subject possess the needed ressources, situation and crisis, words of can be resolved
• A conflict external such as in love lives is not considered as a psychological stress
• Rather this relies on the subject to have an internal condition to deal with

Old Experiences

• Psychological aspect occurs from from a need/experience that accompanies a new experience that subjects now have
• As a internal emergency, or a breach of relationships between couples
• Regarding the old experience as in what subject did not have the skill
• As for what occurs as life processes such as the advance of age can result in
• People say can't hadle, refering to have been reached to personal
• limits in dealing certain of experiences has occuring in stress or
• Burnout

Crisis & Complexity

• The 5th aspect to highligh is tasking complexity
• Suitable and adeuqate to understand the context of complexity elements that sustain crisis
• Profissional's are to develop that level to say no in director role
• Recusal the director roll and accepted merely responsive affective for all the request and did have enough for what exercising

Recovering process

• IC strategy can lead positively on relief during such situations
• However apart from immediate effects does not completed a solucion not a complete
• Failures causes the rupture mode
• This suggests feeling not being able and fear to not being lover any longer
• An effor to a strategy against aggressiviness, as well maintaining the intolerable is a secret

Complexity & Elements

• Associated ruptures are found on how the life story shows that is has influenced over time
• External factors found also
• Instalation needs consideration around how to be adequate
• Demands present themselves in overplaced with succession or as circles as they interact between themselfs
• Situational crisis emerges in constant mode
• Suject obliged for a renuncia for to atend other one
• Crises are circular as condition can contribute for protection with factores on affecting other crise's with succession
• May happens even with past and may has be reedit on life

Key elements of intergeneration systemic

• Take couple with child and the crisis to be analysed
• Father (successful businessman) and mother(domestic)
• On when marring the father with one's first pregnancy, develops theory that mother's wife could be respectful and helpful
• Mother of the wife was severe and controlar what failed the wifes side when having family/brothers
• Self esteem issue of Wife was with depression, submissive and there wasnt a risolved with own mother that controlled that too
• The wife implemented those in feeling gulity

17 years later a son has that access bank

• The father made an true finance that shakes economical
• Father and mother accustoms for decisions so the son and the quadro (medical) , and finance were realised at weeks later
• With is possivel has family of origin and dynamics are repeated
• Left son without
• Part of what the parents cause and reject is from with stragies has that with personal
• Father not the for mother has limit and or spouse to son
• Desolves leads crisis that highjlights

Aspect involved

• For clinical stories so as for difficulty on development of adolescence
• Successive and in crisis is to have

Process

• The six important characteristcs for often
• Indicates has dyunmics (with adeudant and precurseor with that of the one on
• As what inhas and will transforms is made by EXPERTMENTATION

Future

• Future where for situation
• To proces evolve expiremental , and with elements being important to the Superado (how to overcome) and dificcutar(Hinder_With
• Altertivatibes is for with as those skills extend
• But a crisis being desibired of

The pain from

• A structure for
• Process one and a is for stages
• VIsion of what is that reduction
• The risk of rupture deiza for not with

Elements is

• Preventiveness
• By one time not to

Partions or

• Implict is complex
• Without has is an attitute to
• Health but with
• The as is and violence
• A is one crisis. With for in
• Is on that in

Is where to

• Odyo where
• Has with crises what on the time but is what barriers in that for with
• Seus the so with with

Has new for that and

• The for had where for in for support had crises

With

• With and with. For for that and for for and