On the last track, we discussed three phases of a crisis group therapy teschnique. These three phases are the formulation of a crisis situation, intervention, and termination.
On this track, we will discuss three factors influencing client equilibrium during crisis resolution. These three factors are perception of the event, situational supports, and coping mechanisms.
Meredith and Kelley, both 21, were seniors in their second to last semester at college. Both Meredith and Kelley failed a final exam. Meredith was extremely upset and sought help, but did not go into crisis. Kelley, on the other hand, went into crisis during the following week, and sought counseling. In examining the cases in both clients, I identified three key differences between Meredith and Kelley that influenced how each reacted to their failing grade on a final exam.
As you hear these comparisons, contrast them to a crisis client you are currently treating or have treated in the past.
Client Equilibrium During Crisis Resolution - 3 Influencing Factors
#1 Perception of the Event
A first key factor that can affect client equilibrium during crisis resolution is the perception of the event. Clearly, a client’s perception of the event is closely tied to her or his cognitive style. Meredith and Kelley’s differing cognitive styles influenced how they both took in, processed, and utilized the information from their environment. Kelley’s cognitive style was very field-dependent. She relied on external objects in the environment for her orientation to reality, and also tended to use repression and denial as coping mechanisms. Meredith, on the other hand, displayed a field-independent cognitive style, and was more prone to use intellectualization as a defensive mode.
3 Stages of Appraisal
Meredith and Kelley also differed in their appraisal styles. As you know, appraisal occurs in three stages. I stated to Kelley, "when a threatening situation emerges,
1. First, there is a primary appraisal made to judge the perceived outcome of the event in relation to your future goals and values.
2. Second, there is a secondary appraisal. Here, an individual assess the range of coping alternatives available either to master the threat or achieve a positive outcome.
3. The secondary appraisal leads to ongoing reappraisals as coping activities are selected and initiated, and feedback cues from changing internal and external environments lead to changes in the original perception."
Clearly, if during the appraisal process the client judges the potential outcomes to be too overwhelming, the client is much more likely to resort to intrapsychic defense mechanisms to repress or distort the reality of the situation. Consequently, this may lead to an inability to perceive the connection between the precipitating event and the crisis state. Meredith perceived her failing grade as the result of not preparing well for her exam. She decided to reevaluate her study methods, and decided that she would never have a repeat experience. Kelley, on the other hand, stated, "I am a complete failure! I just don’t have what it takes! I’m never going to graduate from college!"
#2 Situational Supports
A second key factor that can affect client equilibrium is situational supports. Meredith’s appraisal skills regarding interpersonal support were strong. She spoke with her roommate about her feelings regarding failing the exam, and called home for reassurance from her family. Kelley, on the other hand, did not feel close enough to her roommate to talk about the problem, and did not call home. Kelley stated, "I didn’t want my family to know I failed. It’d just prove what a disappointment I am to them. And I don’t want to tell my friends about it. They just won’t look at me the same way anymore." Kelley’s own self-doubt led her to fear disclosing imagined inadequacies to the people in her life, and to appraise potential sources of support as threatening to her self-esteem.
#3 Coping Mechanisms
In addition to perception and situational support, a third key factor that can affect client equilibrium is the client’s coping mechanisms. According to Albert Bandura, the strength of an individual’s conviction in her or his own effectiveness in mastering a problematic situation determines whether coping behavior will be attempted in the first place.
Meredith recalled that in other less stressful situations, talking the problem out had reduced her tension. She therefore decided to talk to her roommate, which reduced her tension and anxiety, allowing Meredith to focus on a specific plan for improving her study methods, restoring equilibrium. Kelley had not developed any coping mechanisms in which she had confidence. Instead, she withdrew, and her tension and anxiety increased. Unable to solve the problem and unable to function, Kelley had entered a crisis state.
Differential Relaxation Technique
I decided to immediately address Kelley’s lack of any coping mechanisms by introducing the differential relaxation technique. She had repeatedly complained of muscle cramping. The first part of learning differential relaxation is for the client to observe which muscles and areas of the body are required to perform certain tasks, and which are not. I asked Kelley to keep a diary for a week of what muscles and body areas she was aware of using during her typical daily activities.
I then practiced with Kelley some standard techniques for relaxation breathing and progressive relaxation. For differential relaxation, we combined these techniques with Kelley’s new understanding of what muscles different tasks required. We chose to focus first on relaxation in class while taking notes.
4-Step Differential Relaxation Technique
Step One: Remain in an attentive sitting posture and focus on what the teacher is saying. While maintaining your focus, tune in on breathing with an emphasis on relaxation.
Step Two: Notice the areas that are involved in the activity, your shoulder, neck, arm, and hand. Now, shift your focus to the parts of your body not in use.
Step Three: Suggest to yourself letting go of all tension, sinking down in the chair, feeling heaviness and the pull of gravity on the parts of your body in rest.
Step Four: Once you have released your tension, return your full focus to the lecture. Periodically scan your body for tension. If you detect any tension in the parts of your body at rest, slowly breathe this tension away.
Clearly, this differential relaxation technique can be adapted for any of Kelley’s daily tasks. Think of your Kelley. Would the differential relaxation technique be a valuable addition to her or his list of coping skills?
On this track, we have discussed three factors influencing client equilibrium during crisis resolution. These three factors are perception of the event, situational supports, and coping mechanisms.
On the next track, we will discuss four sociocultural factors that affect therapeutic intervention during a crisis. These four factors are differing cultural values, class stratification systems, lower socioeconomic groups, and barriers to therapy.
Peer-Reviewed Journal Article References:
Chronister, K. M., Linville, D., Vargas, K., & Baraga, F. (2020). Critical consciousness development in a group intervention context: Examining clinician and participant verbalizations. Group Dynamics: Theory, Research, and Practice, 24(4), 227–246.
Faubert, S. E. (2020). Review of Crisis intervention: Building resilience in troubled times [Review of the book Crisis intervention: Building resilience in troubled times, by L. G. Echterling, J. H. Presbury & J. E. McKee]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(3), 237–238.
Hill, N. T. M. (2020). Review of Reducing the toll of suicide: Resources for communities, groups, and individuals [Review of the book Reducing the toll of suicide: Resources for communities, groups, and individuals, by D. De Leo & V. Poštuvan, Eds.]. Crisis: The Journal of Crisis Intervention and Suicide Prevention.
Jones, E. E., Wynne, M. F., & Watson, D. D. (1986). Client perception of treatment in crisis intervention and longer-term psychotherapies. Psychotherapy: Theory, Research, Practice, Training, 23(1), 120–132.
Meixner, C., O'Donoghue, C. R., & Witt, M. (2013). Accessing crisis intervention services after brain injury: A mixed methods study. Rehabilitation Psychology, 58(4), 377–385.
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