Case Scenario
A newly appointed counselor at a well-resourced urban high school in Gauteng, South Africa, meets with Emma, a 16-year-old Grade 10 learner referred by a teacher due to recent sadness, tearfulness, poor concentration, and sleep difficulties. The school allows six counselling sessions, with referrals made when necessary.
During a 90-minute session in a private office, Emma confirms her symptoms and shares concerns about weight gain, body shame, declining academic performance, and lack of motivation. Her parents separated a year ago; her father has little contact and provides inconsistent financial support. Her mother works long hours, appears emotionally withdrawn, and recently asked Emma to find part-time work to assist financially. Emma also cares for her younger brother daily.
Additionally, her boyfriend has recently cut contact, and a public comment by a gym teacher about her weight has intensified her distress. Emma expresses feeling like a burden and states that she sometimes wishes she would not wake up, doubting whether counselling can help her.
Definition of Crisis
A crisis occurs when a person’s situation disrupts their normal balance and violates their fundamental beliefs about others, themselves, and the world. Herbstand Reitsma (2016) indicates that a crisis often occurs immediately, as the causing event may be unexpected. For instance, Emma is in crisis as she may have been overwhelmed by rapid weight gain, fallen behind with her schoolwork, and experienced a sudden communication breakdown with her boyfriend. Her case is characterized by multiple stressors that impact her life simultaneously, leading her to consider herself a burden to everyone.
This paper aims to describe different crisis intervention theories and assess Emma’s emotional state using the triage framework. The paper further describes the coping mechanisms that apply to Emma’s case and discusses the Golan integrative intervention model. It also covers several crisis intervention techniques and the concept of countertransference in crisis/trauma counselling. Crisis counselling can help address Emma’s immediate needs and guide her in developing coping skills to address her current predicament.
Theories of Crisis Intervention and Current Perspectives
Crisis intervention became prevalent over the course of a century in response to society’s diverse sociological challenges. People started to experience increasing societal pressures as early as 1906, which invoked suicidal tendencies among people. However, the first development of crisis theories occurred in 1944, when Dr. Erich Lindemann published a paper in response to the catastrophic Cocoanut Grove disaster (Duffey & Haberstroh, 2020). According to Duffey and Haberstroh (2020), the fire catastrophe occurred in 1942 and led to the death of 492 people, which occurred two years after the fire raced down the Rhythm Club in Natchez, Mississippi, killing 209 souls.
Gerald Caplan continued Lindemann’s work in his 1961 and 1964 publications (Pau et al., 2020). Gerald Caplan provided a profound definition of a crisis, offering a better understanding of the psychodynamic framework that was widely applied at the time. Caplan is acknowledged for describing and documenting the four steps of crisis response and highlighting the’ personalized disposition of crises. However, the psychodynamic approach focuses primarily on the inter-individual, whereas psychoanalytic theory focuses on the intra-individual. Other early theories that focus on crisis intervention include interpersonal, family systems, chaos, transactional, and adaptation theories.
The crisis theory has continued to evolve and incorporates many other elements that may be confusing today. However, the different current perspectives can be grouped into various categories. The developmental perspective encompasses crises that arise within the ordinary course of human development. According to Sokol et al. (2021), crises primarily occur when a significant transformation or change occurs, leading to an atypical reaction. For instance, Emma could have been suffering from an attachment crisis as a teenager since her mother and father separated a year ago, and her father rarely contacted her and forgot to phone her on her birthday.
The existential perspective encompasses crises that occur when one begins to question or reevaluate their values, life’s purpose, and meaning, as well as their commitments (James & Gilliland, 2017). For instance, Emma feels she has become a burden to everyone, to the point that she wishes to sleep and never wake up. The traumatic perspective encompasses crises that occur suddenly, spontaneously, and intensely. Emma could be affected by a traumatic crisis due to her rapid gain in weight, which makes her feel embarrassed.
Assessment of Emma’s Emotional State
Overview of Triage Assessment
Emma’s emotional state can be analyzed using the triage assessment, which incorporates various elements. According to James and Gilliland (2017), triage assessment is a multi-dimensional approach that involves three critical dimensions of the crisis and is founded on the assumption that individual responses during a crisis are situational, unique, and normal. The three domains assessed under the triage model include behavioral, affective, and cognitive. Affective reactions may be fear, anger, or sadness, while cognitive reactions could be physical, emotional, or psychological. Behavioral reactions can be classified either as avoidance, approach, or immobility. All three domains apply in describing Emma’s emotional state.
Affective Domain
In the affective domain, Emma can be considered fearful, as she is unable to talk to her mother, who returns home late in the evening; she is usually irritable and has her own troubles. She is sad that since she has gained weight, her boyfriend may have avoided contacting her on WhatsApp and even blocked her on Facebook. She also expresses anger that her father rarely contacts her and is cohabiting with his new girlfriend, whom she has met twice and apparently dislikes.
Cognitive Domain
In the cognitive domain, Emma can be considered to have her physical needs not met, as she does not feel safe in the absence of her father and has to cope with her highly irritable mother. Her psychological state is affected as her mother requested her to take up a job and support her to pay their bills, and she has to take care of her younger brother. She is also affected emotionally as her boyfriend has stopped contacting her, possibly due to her gaining excess weight.
Behavioral Domain
On the behavioral front, Emma appears avoidant, as her rapid weight gain has led her to feel reluctant to attend school in the mornings and to prefer staying home and watching TV. She further wishes that she could go to sleep and never wake up. She is not pleased with her father’s behavior due to his failure to contact her and his default on his financial maintenance obligations.
Coping Mechanisms
Coping relates to any measure someone takes to contain anxiety or deal with a loss. It is a process that involves behavioral and cognitive activities after appraising the situation at hand and evaluating any potential for harm and the effects of acting responsibly (Herbst & Reitsma, 2016). Initially, Emma could consider directly addressing the situations, avoiding any dangers that might arise, managing her imagination, particularly regarding her boyfriend, and containing her emotions.
However, Emma feels overwhelmed by some of the crisis circumstances and is exposed to overwhelming subjective distress, and is characterized by anxiety. Her crisis has made it hard for her to function socially, at school, in her relationships, and at home. Therefore, Emma can cope by actively seeking reality and searching for information. She could seek to understand why her boyfriend had not responded to her on WhatsApp, why her father had not supported their financial maintenance, and why her parents had separated.
She could also consider breaking down her troubles into manageable units and handling them one at a time. She could probably separate problems into those affecting her at school, at home, with her parents, and her boyfriend, and handle them separately. She can seek further support by expressing herself positively or negatively. For instance, Emma can tell how she feels toward her father and her new girlfriend.
She could also appreciate that her mother could be acting strangely due to fatigue and should support her where possible. Emma should invest in trusting herself and others, rather than being avoidant and wishing the worst for herself. Finally, Emma should master her responses to different circumstances and be adaptable, willing to adjust to events, which can help her cope with weight gain. These coping approaches can help Emma manage her anxiety and feelings of loss and enhance her functioning.
Integrative Intervention Model: Golan Model of Crisis Intervention
Overview
The Golan Model of Crisis Intervention is one of many integrative intervention models developed. The model is named after Naomi Golan, a celebrated pioneer scholar in crisis intervention, as recognized in her 1978 book, Treatment in Crisis Situations (Duffey & Haberstroh, 2020). In this book, Golan discusses three stages of crisis intervention that have been incorporated into contemporary practice. The three phases evolve through five to six sessions, including assessment, implementation, and termination.
Assessment
The first stage of evaluation involves identifying the circumstances leading up to the crisis, understanding the client’s reaction, the crisis context, and the nature of the stressor. The step also involves specifying the crisis’s effect on the client and their primary worry. The four main components of this stage, as proposed by Golan, include an active crisis or disequilibrium, a precipitating factor, a vulnerable state, and a hazardous event (Warrender et al., 2020). The specific crisis counselling technique applicable to Emma’s case entails defining her problem by specifying the particular issue that needs to be settled, mitigated, or minimized.
Implementation
The second stage of the Golan model involves implementing the proposed interventions. The stage encompasses approximately four sessions following the identification of treatment goals, which is done in collaboration with the client. Critical undertakings through this stage involve collecting data on Emma’s pre-crisis functioning, coping processes, and the support provided. The information helps her develop concrete goals.
Some crisis counselling techniques applicable to Emma during the process entail ensuring she is safe physically and mentally. As she wonders whether she can be assisted, it is vital to communicate by offering support, reassuring her, and allowing her to remain calm so that she can be helped. Baumgardt and Weinmann (2022) state that the approach facilitates the enactment of unconditional positive regard, which is available to her during the healing process. Another approach to helping Emma is to critically assess her situation to identify available options that can support her. The alternatives can then be applied to collaborate with her in developing a plan by reflecting upon the options and arriving at a conclusion.
Termination
After implementation, Golan suggests that the final stage is the termination of therapy. This occurs during the last sessions after Emma has made steps to regain her pre-crisis functioning. A plan is made through collaboration to wrap up the sessions and plan for the future. It is vital to gain Emma’s commitment so that she can work toward a safe and therapeutic future in the near term.
Crisis Intervention Techniques
Crisis intervention techniques aim to help clients navigate and overcome a crisis. The methods focus on acknowledging and attending to a distressed person’s needs to avoid potential harm and facilitate gaining control over the problem. According to Baumgardt and Weinmann (2022), there are numerous crisis intervention techniques, but all focus on helping the client manage their emotions and work through the crisis. This can be achieved by reducing distress, protecting the individual from additional stress, providing resources and a suitable support system, and finding a solution to the specific problems.
Building Therapeutic Relationship
Emma’s situation can first be contained by creating a positive connection with her during the initial stages of interaction. Emma is doubtful whether she will be assisted, and this offers the best opportunity to state that she can be pled to confound the difficulties. This can be done by accepting help, being supportive, and showing respect and eagerness to help her.
The expression of willingness to help should be conveyed through a profound reflection on Emma’s feelings regarding seeking help. She can continue expressing herself so she can share her perspective on the kind of help she is seeking. According to Pau et al. (2020), this can be achieved by encouraging her to fully express her feelings and vent her pain before discussing the specific events that comprise the crisis. For instance, Emma should be able to state whether she feels helpless or distraught before attempting to discuss the crisis’s justifications. There are instances where clients may be immediately prompted to reflect on the crisis before expressing their emotions.
Problem-Solving
Another approach is to use problem-solving techniques, especially given that Emma feels overpowered and unable to see a way out. She can be assisted by separating her challenges into manageable units and then exploring the appropriate solutions. Problem-solving techniques require brainstorming, evaluating gains and losses, and considering alternative viewpoints (Baumgardt & Weinmann, 2022). This requires critical thinking and empowering Emma to consider practical solutions. Emma can also be assisted by encouraging her to contain her feelings of guilt or shame. This is particularly associated with her thinking that her performance and neglect by her boyfriend could be due to her rapidly gaining weight. She can be talked to openly and honestly about the issues so that she better understands her feelings and starts to take steps to handle them.
Safety Planning
Emma also requires safety planning, considering that she has repeatedly stated her wish to sleep and never wake up. This could be translated to mean engaging in self-harm or suicide. Warrender et al. (2020) suggest that a comprehensive plan should be developed to ensure her safety, identify triggers, develop coping strategies, and establish a support system. The safety plan can enable Emma to take control of her predicament and access the suitable resources she may need.
It is also vital to test the reality of the solutions by challenging and helping Emma to assess her beliefs, thoughts, and perceptions. This can help her to examine and consider alternative perspectives. She could also gain a better understanding of the situation, such as the reason for her parents’ separation and her father’s infrequent contact with her. She can also reduce the distress associated with negative thinking, particularly with her rapid weight gain.
Countertransference and Crisis/Trauma Counselling
Countertransference is a phenomenon that occurs during therapy when the therapist transfers their personal feelings and thoughts onto the client. Alger and Gushwa (2021) indicate that the concept was developed by Sigmund Freud, who suggested that countertransference is an unconscious feeling where the client impacts the therapist’s emotions. Countertransference in crisis/trauma counseling involves reactions characterized by bitterness, jealousy, anger, or admiration that may be attributed to the counselor’s past encounters. The counselor may also act out of feelings of inadequacy or a desire to feel important, even though this may not be intended to serve the client’s interests. In other cases, a counselor’s countertransference may be a reaction to a client’s conduct.
Countertransference can also occur consciously, leading to a harmful or unethical demeanor toward a client. However, recent findings suggest that countertransference can be beneficial if a counselor recognizes it and uses it to positively affect the outcomes (Alger & Gushwa, 2021). Countertransference may occur in the case of Emma if the counselor or psychologist inadvertently discloses her personal struggles to other students.
It could further occur when no defined boundaries exist for interacting with her. For example, this could involve taking advantage of her boyfriend’s neglect to develop and express strong romantic feelings toward her. It could also occur through overly criticizing Emma for rapidly gaining excess weight. Countertransference may also arise through excessively supporting Emma due to her predicaments at home or with her father. It may also happen if personal sentiments or experiences interfere with the process of providing the necessary therapy.
References
Alger, B., & Gushwa, M. (2021). Managing countertransference in therapeutic interactions with traumatized youth: Creating a pathway to making discomfort comfortable. Smith College Studies in Social Work, 1–21.
Baumgardt, J., & Weinmann, S. (2022). Using crisis theory in dealing with severe mental illness–A step toward normalization? Frontiers in Sociology, 7.
Duffey, T., & Haberstroh, S. (2020). Introduction to crisis and trauma counseling. American Counseling Association.
Herbst, A., & Reitsma, G. (2016). Trauma counselling: Principles and practice in South Africa today. JUTA and Company (Pty) Ltd.
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Cengage Learning.
Pau, K., Ahmad, A., & Tang, H.-Y. (2020). Crisis, disaster, and trauma counseling: Implication for the counseling profession. Journal of Critical Reviews, 7(08).
Sokol, R. L., Heinze, J., Doan, J., Normand, M., Grodzinski, A., Pomerantz, N., Scott, B. A., Gaswirth, M., & Zimmerman, M. (2021). Crisis interventions in schools: A systematic review. Journal of School Violence, 20(2), 241–260.
Warrender, D., Bain, H., Murray, I., & Kennedy, C. (2020). Perspectives of crisis intervention for people diagnosed with “borderline personality disorder”: An integrative review. Journal of Psychiatric and Mental Health Nursing, 28(2).