Abstract: One of
the most pressing needs for many victims in the aftermath of crime
is providing emotional first-aid through crisis intervention.
As a result of the trauma they have suffered, victims often need
immediate, comprehensive support and assistance to deal with new
and often troubling emotions and reactions. Victim service providers
who possess a knowledge of basic crisis intervention skills can
provide valuable services and support to victims in what is often
their greatest time of need.
Upon completion of this chapter, students will understand the
1. Stress and crisis theories as they apply to crisis intervention
2. How to better communicate with victims/survivors at the crisis
stage of their victimization.
3. A crisis intervention model that can be applied to victims
with acute psychological crisis, acute situational crisis, and
acute stress disorders.
4. Basic techniques for crisis intervention.
Victim service providers may be called upon, on a regular basis,
to provide victims and survivors with crisis intervention support
and assistance. Knowledge about stress and crisis theory and practical
applications for helping victims/survivors is a crucial component
of victim advocacy skills.
It is important for victim advocates to possess a basic understanding of stress theory, which was developed by Dr. Hans Selye and others. Routine stressors are present in the physical and social environment. Generally, people cope with the anxiety that stress creates in adaptive and maladaptive ways. Adaptive methods of reducing anxiety include exercise, relaxation techniques, expressing feelings, engaging in task-oriented behavior, etc. These behaviors help an individual to "maintain emotional and functional equilibrium." Maladaptive behaviors that people may use to reduce the effects of stress include "chemical substance abuse, denial, aggression, suicide attempts, psychosomatic complaints, an social withdrawal." (Andrews, 1990)
In addition to routine stressors, people may also experience extraordinary stressors that, in combination with routine stressors can cause intense stress. Extraordinary stressors may include loss of a loved one, loss of a job, moving to a community, etc. (Andrews, 1990) Developmental stressors, related to transitions in life, such as adolescence, marriage, parenthood, and retirement, are experienced by most people and can cause intense stress for a prolonged period of time. Chronic stressors occur repeatedly, can produce high levels of anxiety, and disrupt a person's equilibrium. These might include abusive relationships or particularly stressful job situations. Depending upon the coping abilities of the individual involved and the combination of multiple stressors, an individual may experience a temporary state of psychological crisis.
Catastrophic stressors are described by Figley (1985) as "sudden, overwhelming, and often dangerous, either to one's self or significant other(s)." Catastrophic stressors often cause trauma, "an emotional state of discomfort and stress resulting from memories of an extraordinary catastrophic experience which shattered the survivor's sense of invulnerability to harm." Examples of such powerful stressors include violent crime victimization, airplane crashes and other life threatening events.
As described in the "Staff Victimization and Critical Incidents" chapter of "Crime Victims and Corrections: Implementing the Agenda for the 1990s" (published by the National Victim Center in 1993 [second edition] with support from OVC), stress theory contains the following premises:
Crisis theory can trace its roots back to antiquity. For example, in ancient Greece, the word crisis came from two root words -- decision and turning point. In the Chinese language, two symbols represent the word crisis -- danger and opportunity.
According to Roberts, the term crisis is defined "as a temporary state of upset and disequilibrium, characterized chiefly by an individual's inability to cope with a particular situation using customary methods of problem solving and by the potential for positive or negative outcome." (Roberts, 1995) In earlier research by Burgess and Baldwin (1981), it was stated that when "an individual experiences an emotionally hazardous situation and is unable to effectively utilize previously learned coping behaviors, then emotional crisis may ensue."
Roberts (1990a) summarizes the history of the development of present-day crisis theory. In general it can be said that numerous mental health practitioners have contributed to our current understanding of crisis. Work with soldiers experiencing "combat neuroses" in World War II, veterans who served in combat in Viet Nam, survivors of catastrophic events such as a fire in Boston in which 500 people were killed, have helped to shape the view that "crisis is not, in itself, a pathological state, but a struggle for adjustment and adaptation in the face of problems that are, for a time, unsolvable."
Butcher and Maudal (1976) also provide an overview of the assumptions of crisis theory:
To address the immediate characteristics of an individual experiencing crisis -- a theory and practice evolved that is today known as crisis intervention. This technique was designed to facilitate crisis resolution through adaptive rather than maladaptive means. When used with survivors of violent crime, it is understood that no intervention can erase the pain of the victimization itself, however the survivor may be helped "to avert residual damage and promote new strengths for coping with the memories and future similar challenges." (Andrews, 1990)
Crisis intervention with victims of crime often addresses the specific characteristics of the crisis producing event, the immediate reactions of shock, denial and disbelief, and the subsequent by confusing emotional reactions such as guilt, self-blame, anger, and fear, with the goal of reconstruction of an individual's equilibrium.
By definition, crisis intervention is to be used for crisis specific
traumas -- not as an intervention for long-term mental health
problems. Typically, crisis intervention is also time limited.
As a short-term, immediate intervention for crime victims, its
goal is to help the victim identify and cope with the sense of
'disequilibrium' in the aftermath of a trauma.
Developing an Awareness of Crisis
Andrews (1990) describes people in a crisis state as follows:
"People in crisis may have uncontrolled emotional expressions,
disorganized thoughts, anxiety, and fatigue. They may have difficulty
completing routine tasks and may withdraw from or cling to social
contacts. The person in crisis is highly vulnerable to influence
by others, acts helpless, and may appear to be psychopathological
or suffering form chronic stress, In fact, the symptoms are temporary,
typically resolved within a few weeks. The return to normalcy
may be misleading, as serious residual psychological damage may
The victim service provider who is aware of a victim's crisis state can accomplish two important first steps with the initial contact with the individual in crisis. The advocate can administer "emotional first-aid", which can be described as verbal or non-verbal communications that are supportive and attempt to relieve the victim of extreme emotional distress. The goal is to help the victim feel heard, understood, and accepted. The victim can also be guided or assisted to begin participating in problem-solving to address the crisis. The advocate should understand that in a crisis situation issues previously contained or managed by the defenses of the victim may be triggered.
Auerbach and Kilmann (1977) describe the general factors in crisis intervention approaches as follows:
Professionals working in private practices, at community mental health centers, or in hospital settings are often charged with responding a wide array of mass emergencies, disasters, and victims of violent crimes and other traumatic events. Various practice models have been developed to work with persons in crisis.
Roberts' seven-stage crisis intervention model can be applied
to victims experiencing acute crises to facilitate early identification
of crisis precipitants, problem solving, and effective crisis
The seven stages of the crisis intervention model are as follows:
1. Plan and conduct a thorough assessment (including lethality and dangerousness and immediate psychosocial needs).
Effective intervention and brief treatment with persons in crisis (e.g., adolescent suicidal patients, survivors of incest, alcohol clients, parents of abducted children, etc.), should always should begin with a thorough intake assessment or collection of background information by the therapist. Subsequent crisis interventions should be based on this initial assessment.
A critical part of any assessment with depressed, suicidal, sexually
assaulted, or battered women survivors is a lethality or level
of danger assessment; published lethality scales may be used,
but determining if the patient is currently in danger is of critical
importance (e.g., battered women who recently received death threats
from their batterers or child victims of sexual abuse or exploitation
who are currently residing with the identified abuser.)
2. Establish rapport and rapidly establish the relationship (conveying genuine respect for and acceptance of the client, while also offering reassurance and reinforcement that the client, like hundreds of previous clients, can be helped be the therapist). Reactivating the problem-solving ability of the victim can also be initiated at this stage.
When working with many victims of crime, e.g. bank robbery victims,
stranger assaults or robberies, stage one and two may be interchangeable,
as many victims are not in danger of further harm or injury following
the crime. Thus, establishing rapport becomes the initial focus
of the intervention. However, with certain types of victims, e.g.
battered women, stalking victims, victims of gang violence, assessment
of dangerous and development of a safety plan is the appropriate
3. Identify major problem(s). This step includes identifying
the "last straw" or precipitating event that led the
client to rank order and prioritize several problems and the harmful
or potentially threatening aspect of the number one problem. It
is important and most productive to help the client to ventilate
about the precipitating event or events; this will lead to problem
identification. Sometimes clients are in a state of denial. Other
times clients have an all-consuming need to ventilate, and ventilation
of feelings is important as long as the therapist gradually returns
to the central focus: the crisis precipitant or actual crisis
4. Deal with feelings and emotions. This stage involves
active listening, communicating with warmth and reassurance, nonjudgmental
statements and validation, and accurate empathetic statements.
The person in crisis may well have multiple mood swings throughout
the crisis intervention. As a result, nonverbal gestures such
as smiling and nodding might be distracting and annoying to the
person in acute crisis. Therefore, the author suggests the use
of verbal counseling skills when helping the client to explore
his or her emotions. These verbal responses include reflecting
feelings, restating content, using open-ended questions, summarizing,
giving advice, reassurance, interpreting statements, confronting,
and using silence.
5. Generate and explore alternatives. Many clients, especially
college graduates, have personal insights and problem-solving
skills as well as the ability to anticipate the outcomes of certain
deliberate actions. However, the client is emotionally distressed
and consumed by the aftermath of the crisis episode. It is therefore
very useful to have an objective and trained clinician to assist
the client in conceptualizing and discussing adaptive coping responses
to the crisis. "In cases where the client has little or no
introspection or personal insights, the clinician needs to take
the initiative and suggest more adaptive coping methods"
(Roberts, 1990, p.13). During this potentially highly productive
stage, the therapist/crisis intervenor and client collaboratively
agree upon appropriate alternative coping methods.
6. Develop and formulate an action plan. Developing and
implementing an action plan will ultimately restore cognitive
functioning for the client. This active stage may involve the
client agreeing to search for an apartment in a low-crime suburban
area, for example, or it may involve the client making an appointment
with an attorney who specializes in divorce meditation, or agreeing
to go to a support group for widows or persons with sexually transmitted
diseases (STDs). Many clients have great difficulty mobilizing
themselves and following through on an action plan. Clients in
crisis need to hear that you have had other clients who have failed
and have been lethargic, yet have made an all-out effort to overcome
the obstacle and were successful in resolving the crisis.
7. Follow up. Stage seven in crisis intervention should
involve an informal agreement or formal agreement or formal appointment
between the therapist and client to have another meeting at a
designated time, either in person or on the phone, to gauge the
client's success in crisis resolution and daily functioning one
week, two weeks, or one month later.
(Excerpted from: "Epidemiology and Definitions of Acute Crisis
in American Society" in Crisis Management and Brief Treatment:
Theory, Technique, and Applications, A. R. Roberts, Editor,
Nelson-Hall Publications, Chicago, IL, 1996)
Additional Considerations in Communicating with
Dealing with angry, frustrating or manipulative victims is an area that is particularly difficult for professionals who provide assistance to crime victims. In addition, the trauma of victimization may create or exacerbate a substance abuse problem for a victim.
Victim assistance providers should be aware that the victim will be assessing them as closely as they will be assessing the victim. There are a number of precautionary points the victim assistance provider should be aware of:
Crises as "Triggers"
A crisis situation may serve to reawaken (trigger) unresolved problems or previous traumas in an individual. The victim service provider should be attuned to such cues and use this opportunity to support and assist the victim:
Communicating with Withdrawn or Silent Victims
Special problems may arise when communicating with the withdrawn
or silent victim, who will not usually initiate interaction. These
problems may include:
Even if no communication on the part of the victim occurs, if
the above procedures are followed, the victim assistance provider
is, at the very least, establishing rapport with the victim.
Three basic techniques for crisis intervention have become an
accepted standard in providing immediate intervention to crime
victims and survivors in the aftermath of trauma. As described
by Dr. Marlene Young, Executive Director of the National Organizational
for Victim Assistance, these three techniques are:
1. Safety and security.
2. Ventilation and validation.
3. Prediction and preparation.
Safety and Security
The first concern of any crisis intervenor should be for the physical safety of the victim. Until it is clear that the victim is not physically in danger or in need of emergency medical aid, other issues should be put aside. This is not always immediately obvious. Victims who are in physical shock may be unaware of the injuries they have already sustained or the dangers they still face.
For the crisis intervenor who is responding to a telephone crisis call, the question should be immediately posed, "Are you safe now?" Intervenors who are doing on-scene or face-to-face intervention should ask victims if they are physically harmed. This question alone may cause the victim to become aware of a previously undiscovered injury.
A parallel concern should be whether the victim feels safe. The victim may not feel safe in the following circumstances:
Any of these situations may make the victim feel unsafe even if
there are law enforcement officers present.
A priority for some victims and survivors is the safety of others as well. If a couple has been robbed in a street crime, each may be more worried for the other person than for himself or herself. Parents are often more concerned about the safety of their children than themselves.
Survivors of victims of homicide may not focus on safety, but rather seek a sense of security through the provision of privacy and nurturing. Their anguish and grief can be made more painful if there are unfamiliar and unwanted witnesses to their sorrow.
They, too, will suffer feelings of helplessness and powerlessness. The shock of the arbitrary death of a loved one is usually not immediately assimilated, and survivors may not understand questions or directives addressed to them.
All victims and survivors need to know that their reactions, comments and pain will be kept confidential. If confidentiality is limited by law or policy, these limits should be clearly explained.
Security is also promoted when victims and survivors are given
opportunities to regain control of events. They cannot undo the
crime or the death of loved ones, but there may be opportunities
for them to take charge of things that will happen in the immediate
Suggestions for Helping
1. Make sure the victims/survivors feel safe and/or secure.
2. Respond to the victim's need for nurturing, but be wary of becoming a "rescuer" on whom the victim becomes dependent. The "rescuer" who ends up months later making decision for the victim has subverted the primary goal of crisis intervention, i.e. to help the victim restore control over his or her life. The following tips suggest appropriate ways in which the crisis intervenor can step in on a temporary basis:
3. Assist survivors in re-establishing a sense of control over the small things in his or her life, then move on to larger ones.
Ventilation and Validation
Ventilation refers to the process of allowing survivors to "tell their story." While this seems to be a simple concept, the process is not easy. Victims need to tell their story over and over again. The repetitive process is a way of putting the pieces together and cognitively organizing the event so that it can be integrated into their lives. The first memory of the event is likely to be narrowly focused on, say, a particular sensory perception or a particular activity that occurred during the event. Victims usually see the criminal attack with tunnel vision. They know intuitively that other things are happening around them, but they may focus on an assailant's knife, their struggle to get away, etc.
As time goes by, memory will reveal other parts of the event. These bits of memory will come back in dreams, intrusive thoughts, and simply in the story-telling process. The victimization story will probably change over time as they learn new things and use the information to reorganize their memories.
From a law enforcement perspective, the problem with this process of reconstructing a story is that it sometimes results in inconsistent or contradictory stories, which undermine an investigation or prosecution. However, from a crisis intervention perspective, it is perfectly normal for the process of ventilation to reveal a more complete story over time. Realistically, a victim will tell his or her story over and over again, with or without a crisis intervenor, in order to reconstruct the event, so the story will change anyway. The difference is that the crisis intervenor will provide a "sounding board" for the victim's distress as the review process unfolds.
For victims, the replaying of the story helps them gain control of the real story. For the "real" story is not only the recitation of the event itself, but usually includes the story of various incidents in the immediate aftermath. Each of these stories must be integrated into the victim's final mental recording of the event.
Ventilation is a process of finding words or other ways that will give expression to experiences and reactions. In this aspect, ventilation is often culturally specific. The power found in putting words to feelings and facts is tremendous. There is often a depth of emotion in telling another person that a loved one has died, even in saying the name of the loved one.
The exact words to describe events and experiences are often very important, I., calling drunk driving crimes "crashes" instead of accidents.
Validation is a process through which the crisis intervenor makes it clear that most reactions to horrific events are "normal."
The focus of validation should be that most reactions of anger, fear, frustration, guilt, and grief do not mean that the victim is abnormal, immoral, or a bad person. They merely reflect a pattern of human distress in reaction to a unique criminal attack.
Suggestions for Helping
1. Ask the victim to describe the event. Ask the victim to describe where he or she was at the time of the crime, who he or she was with, and what was seen, heard, touched, said, or done. These two questions will help the victim focus on the crime in an objective way. It will help the victim impose some order on the event and begin to take control of the story. It may help to ask the victim to recall that day from the beginning, so that the "normal" parts become party to the crisis story.
2. Ask the victim to describe his or her reaction and responses. As the victim begins the description, remember to validate the reactions and responses.
3. Ask the victim to describe what has happened since the crime, including contact with family members, friends, the criminal justice system, and so on. Responses to this question will help reveal whether the victim has suffered additional indignities as a result of the crime, or whether the victim has been treated with dignity and compassion.
4. Ask the victim to describe other reactions he or she has experienced up to now. Again, validate reactions.
5. Let the victim talk for as long as he or she would like and as your time allows for you to listen.
6. Don't assume anything, even if the apparent pattern of the crisis reaction is suspect. For example, the victim's controlled calm of the moment may yield to tears in a few minutes.
7. Don't say things like:
Do say things like:
Prediction and Preparation
One of the most potent needs that many victims have is for information about the crime and what will happen next in their lives. Their lives have typically been thrown into chaos and they feel out of control. A way to regain control is to know what has happened and what will happen -- when, where and how.
The information that is most important to victims is practical information. The following examples may raise possibilities that the victim has not even considered; the intervenor may tactfully touch on such issues or defer them:
The second priority for information is the possible or likely emotional reactions that the victim might face over the next day or two, and over the next six months or so -- emphasizing that there is no particular timetable when victims can expect to experience crisis reactions, or which of the intense emotions may surface. Some of the possible emotional concerns that should be outlined are the following:
Victims should expect that everyday events may trigger crisis reactions similar to the ones they suffered when the crime occurred.
In addition to needing predicable information, victims need assistance
in preparing for ways in which they can deal with the practical
and emotional future.
Suggestions for Helping
(Excerpted from "Mapping Strategies for Victim
Services," National Organization for Victim Assistance and
National Victim Center, 1991)
Self Examination Chapter 11
1) Cite three elements of crisis theory.
2) List three types of stressors, describe them,
and how they might affect an individual.
3) Name three safety concerns of survivors of crime.
4) Briefly describe the process of "validating"
5) What are the first two stages of Roberts' crisis
intervention model and why might they be interchangeable with
Andrews, A.B. (1990). Crisis and recovery services for family
violence survivors. In A.R Roberts (Ed.). Helping crime victims,
research, policy, and practice. Thousand Oaks, CA: Sage Publications.
Auerbach, S. M. & Kilmann, P. R. (1977). Crisis intervention:
A review of outcome research. Psychological Bulletin, 84
Burgess, A.W., & Baldwin, B.A. (1981). Crisis intervention
theory and practice. Englewood Cliffs, NJ: Prentice Hall.
Figley, C.R. Ed.) (1985). Trauma and its wake: A study and
treatment of post-traumatic stress disorder. New York: Brunner/Mazel.
Roberts, A.R. (Ed.) (1990a). Crisis intervention handbook:
Assessment, treatment and research. Belmont, CA: Wadsworth.
Roberts, A.R. (Ed.) 1996. Crisis management and brief treatment:
Theory, technique, and applications. Chicago, IL: Nelson-Hall
Roberts, A.R. (Ed.) (1990b). Helping crime victims, Research,
policy and practice. Thousand Oaks, CA: Sage Publications.
Roberts, A.R. (Ed.) (1995) Crisis intervention and time-limited
cognitive treatment. Thousand Oaks, CA: Sage Publications.
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