A crisis, James and Gilliland write, is an event that is so difficult that it “exceeds [one’s] current resources and coping mechanisms.” The event is such that if the individual does not “obtain relief” they might suffer “severe affective, behavioral, and cognitive malfunctioning up to the point of instigating injurious or lethal behavior to oneself or others” (p. 8). A crisis that reaches this point is considered a behavioral emergency (p. 8).
James and Gilliland divide crises into individual and systemic crises, the latter occurring when traumatic events overwhelm larger bodies of people, rendering their response systems ineffective (p. 9). Both individual and systemic crises can be further divided into developmental, situational, and existential crises. A developmental crisis occurs when a fairly normal event—e.g., the birth of a child, retirement—“produces abnormal responses” (p. 16). A situational crisis occurs when an “uncommon and extraordinary” event—e.g., a car accident, a terrorist attack—produces such results (pp. 16-17). An existential crisis occurs when one experiences anxiety over such existential matters as meaning, purpose, and death (p. 17).
James and Gilliland next talk about metastasizing crises, crises that begin as “small, isolated incident[s]” but eventually spread (p. 9). Some crises continue to hamper individual even after the crises have seemingly been eradicated and life returned to normal (p. 11). PTSD is an example of such a transcrisis, as even though one might appear to be functioning normally, a seemingly minor “added stressor may tip the balance and send them [back] into crisis” (p. 12). Although crises are unpleasant and sometimes disastrous, they can also be opportunities for growth, as the pain they cause can “impel the person to seek help” and “the intervention can help plant the seeds of self-growth and self-realization” (p. 10).
James and Gilliland next look at different theories of crisis intervention. Lindemann and Caplan conceived of basic crisis intervention as helping individuals return to their state of pre-crisis equilibrium (p. 13). James and Gilliland define equilibrium as a state in which one’s “usual coping mechanisms and problem-solving methods” are working to meet their needs” (17). They provide a good metaphor to describe basic crisis intervention, likening someone in equilibrium to “a motorist driving, with some starts and stops, down the road.” The motorist “may hit some potholes but does not breaky any axles,” whereas the individual in disequilibrium is like a motorist who is “experiencing serious difficulty in steering and successfully navigating life’s highway” (p. 50).
Because basic crisis intervention is based on psychoanalytic theory, it does not “adequately address the social, environmental, and situational factors that make an event a crisis” (14). Expanded crisis theory takes this shortcoming into account and encompasses seven different theories: psychoanalytic theory holds that to understand one’s crisis we must understand one’s unconscious thoughts and pre-crisis experiences; systems theory holds that we must understand the different social systems in one’s life; ecosystems theory holds that we must look at all systems related to the individual, small and large; adaptational theory holds that we must try to correct the individual’s “maladaptive coping behaviors”; interpersonal theory holds that we must enhance the individual’s self-esteem (p. 14); chaos theory holds that we must strive to understand the “underlying pattern” behind the seemingly chaotic crisis; developmental theory holds that crises results from one’s failure to pass through the appropriate developmental stages (p. 15).
James and Gilliland next look at the major crisis intervention models. The equilibrium model, already explained in the preceding paragraph, is often appropriate in the early stages of the crisis when the individual most needs emotional stabilization (p. 17). The cognitive model claims that crises are caused or at least worsened by irrational thinking and can be mitigated when those involve adjust their thinking. This model—based on the work of Ellis, Meichenbaum, and Beck—is generally employed after the client has been stabilized (pp. 17-18). The psychosocial transition model holds that the crisis is caused by both external and internal factors and sets to change both in order to help the client. This model is based on the work of Adler, Erikson, and Minuchin, and is also best used after the client is stabilized (p. 18). This model has been manifested in two more modern and somewhat altered models, the developmental-ecological model and the contextual-ecological model (p. 18). Psychological first aid seeks to provide “nonintrusive physical and psychological support” in the immediate aftermath of a crisis. Many feel it is a needed first response, although in most cases additional support is required later on. James and Gilliland advocating using an eclectic approach that is contextually based and draws upon the above theories as the work feels is appropriate (p. 20).
James and Gilliland finally describe the main characteristics of an effective crisis worker. First, poise—equanimity, coolness under pressure. Second, creativity and flexibility—the ability to think outside the box, to approach problems in innovative ways. Third, energy and resiliency—the strength to remain effective with those in crisis. Fourth, quick mental reflexes—because in crisis situations there is usually not time to mull over one’s response. Fifth, assertiveness—the strength and ability to take charge and be directive if needed (p. 22).
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