On the last track, we discussed 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.
On this track, we will discuss four important concepts in the treatment of a cases of crisis precipitated by a sudden status change. These four concepts are understanding social roles, assessment, intervention techniques, and anticipatory planning.
Stanley, 44, had requested help at a crisis center on the advice of his attorney. Stanley had been the president of a new branch of a major advertising company. Three weeks previously, Stanley’s company had closed the office branch of which Stanley was in charge. Stanley found himself suddenly unemployed, and had spent two days immediately following the loss of his job bed bound.
Treatment of Crisis Precipitated by a Sudden Status Change - 4 Concepts
#1 - Understanding Social Roles
A first important concept in the treatment of Stanley’s crisis was understanding social roles. As you know, role conception refers to how the client perceives the effects of his or her role on his or her self concept. The client defines their role according to his or her perception, needs, goals, and basic values. Stanley’s role as a highly paid executive was integral to his positive self-concept. The change of status Stanley experienced resulted in not only loss of his role, but in a loss of positive self concept. Stanley’s crisis was largely tied up in the fact that Stanley’s role concept had been integral in almost every aspect of Stanley’s identity.
#2 - Assessment
A second important concept in the treatment of Stanley’s crisis I felt was the assessment of the crisis situation. Stanley’s initial presentation was with symptoms of insomnia, inability to concentrate, and feelings of hopelessness and failure. Stanley’s move to the new branch had been recent, and had necessitated a cross-country move that had been a negative experience for his wife and children, who had remained mad at him after the move. Despite the stress of the job loss, Stanley had initially been able to bounce back and plan constructively for his family’s security. He had even been able to work with his formerly confrontational spouse on finding a smaller house that fit their projected budget well.
However, Stanley’s current landlord had abruptly threatened a lawsuit through an attorney if Stanley broke his current lease. Stanley’s wife had responded by calling him a self-centered failure who had ruined her life. The threat of a lawsuit left Stanley feeling hopeless, since this in effect destroyed the careful plans he had made for his family’s well-being. In addition, he had lost any situational support from his wife. Stanley had previously coped with stress by working with his wife or business friends. However, Stanley stated, "I can’t call my old buddies about this. I don’t want them to know that I have failed."
#3 - Therapeutic Crisis Intervention
In addition to understanding social roles and assessment, a third concept in the treatment of Stanley’s crisis was the therapeutic crisis intervention. I first conducted a suicide risk assessment with Stanley, which showed Stanley was not having suicidal ideation. I next set two goals for the crisis intervention. The first goal was to assist Stanley regarding exploring unrecognized feelings about his change in role in status. The second goal was to address Stanley’s lack of social support and coping mechanisms.
Technique for Social Work CEUs, Psychology CEUs, Psychologist CEUs,
Counselor CEUs, Addiction Counselor CEUs, and MFT CEUs
Technique: "Small Control"
My initial four crisis intervention sessions with Stanley focused on reestablishing coping mechanisms and addressing Stanley’s depression. One technique that I used with Stanley is the ‘Small Control’ technique.
3-Step Small Control Technique
--Step One: Impose order in your life where you can. I encouraged Stanley to set as a priority easily achievable goals to order his life, such as being on time for appointments, eating regular meals, and adhering to a healthy bedtime. Stanley found it helpful to create a detailed daily schedule. Sticking to the schedule allowed Stanley to feel a daily sense of achievement and control.
--Step Two: Look after your appearance. Stanley had always prided himself as a well-groomed, well-dressed businessman, but since his loss of his role as an executive had let his grooming habits slide. I stated to Stanley, "by neglecting your appearance, you may be reinforcing to yourself that there is no reason to be at your best." I encouraged Stanley to make his old grooming habits a part of his daily schedule.
--Step Three: Take note of the good moments. I stated to Stanley, "You might try keeping a small notebook with you at all times. When something good happens, write it down. That way you can constantly remind yourself that positive things are happening in your life."
By the fifth week, Stanley had made significant changes in his situation. Stanley was able to meet with his landlord and come to an amicable agreement that allowed him to break his lease. Through dealing with his inherent need to be "the boss" Stanley was able to contact old friends for support, and found himself with several job offers. Although the jobs were lesser positions, Stanley accepted one and once again was able to draw a paycheck. Stanley’s family were supportive of his choice, and became actively involved in planning for the move to their new home.
#4 - Anticipatory Planning
A fourth concept in the treatment of Stanley’s crisis was anticipatory planning. Before termination, I reviewed with Stanley the adjustments and tremendous progress he had made in so short a time. I emphasized that it had taken a great deal of strength to resolve such an extremely ego-shattering experience. Stanley stated, "I know there’s no way of preventing something like this from happening again. But… I think I could handle it better if it did. Just the fact that my friends and family didn’t see me as a failure for asking for help… that makes a big difference. Even if I have to accept a lesser circumstance for a while, that doesn’t mean I am a failure or others see me as a failure."
On this track, we have discussed four important concepts in the treatment of a cases of crisis precipitated by a sudden status change. These four concepts are understanding social roles, assessment, intervention techniques, and anticipatory planning.
On the next track, we will discuss three concepts regarding crisis counseling following rape. These four concepts are McDonald’s phases of reaction, guilt, and an intervention technique for rape victims in crisis and their partners.
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.
Kim, D.-H., Rodríguez Andrés, A., & Leigh, J. P. (2020). Sex-specific impact of changes in job status on suicidal ideation. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(2), 89–96.
Mansfield, Y., Hamilton, S., Argus, J., Wyder, M., Macready, R., James, B., Stewart, C., & Meehan, T. (2021). A shelter in the storm—Acceptability and feasibility of a brief clinical intervention for suicidal crisis. Crisis: The Journal of Crisis Intervention and Suicide Prevention.
Roškar, S., Podlesek, A., Kuzmanić, M., Demšar, L. O., Zaletel, M., & Marušič, A. (2011). Suicide risk and its relationship to change in marital status. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 32(1), 24–30.
Zhang, Y., Yip, P. S. F., Chang, S.-S., Wong, P. W. C., & Law, F. Y. W. (2015). Association between changes in risk factor status and suicidal ideation incidence and recovery. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(6), 390–398.
Online Continuing Education QUESTION 9
What are the three steps in the Small Control technique?
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