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On the last track, we discussed 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.
On this track, we will discuss four concepts regarding therapeutic crisis intervention in the case of a premature birth. These four concepts are four tasks for the mother of a premature infant, assessing the family, interventions, and anticipatory planning. We will also discuss the "Carbonated Thoughts’ technique.
Carla and John had been married 4 years, and had a two year old daughter. When Carla was seven and a half months pregnant with the couple’s second child, John’s company transferred them to another city. Within a day of moving to their new home, Carla went into premature labor and delivered a baby boy. Because the new town was 150 miles from their old home, Carla delivered under the care of an obstetrician she had never personally met, in a hospital that was not familiar to her. Although the baby did well, two months after his birth Carla entered a crisis state in which she was no longer able to care for the baby.
#1 - Four Tasks for Mothers of a Premature Infant
#2 - Assessing the Family
Carla stated, "She was just constantly making comments like, ‘I can’t understand why he cries so much. You must be doing something wrong. My children always slept through the night by two months!’ All day long, comments like that!" Jim was reluctant to intervene, and on the second day of his mother’s visit, Carla became extremely upset, cried uncontrollably, and took to bed, refusing to care for the baby. In talking with Carla, I discovered that prior to this event, she had experienced strong symptoms of anxiety, insomnia, exhaustion, and fear over her ability to care for her son.
I next assessed Carla’s sources of situational support. Clearly since she had recently moved, Carla had not had time to establish a strong network of friends in the area. John was extremely reluctant to participate in care for the baby, expressing fear of the baby’s small size and fretful nature. Carla was thus responsible for all of the baby’s physical needs. I also established that John’s mother Doris had been an ongoing source of stress for Carla since she became pregnant with their first child. Doris was very opinionated, and frequently sat Carla down for talks on child-rearing.
Carla had begun to develop confidence in her own mothering abilities recently as her daughter continued to have good health and average development. However, the difficulties of caring for a baby with more challenging needs had convinced Carla that she was too incompetent to care for her new son. Neither John nor Doris was providing situational support for her in her role as the mother of a premature infant.
#3 - Interventions
Technique: "Carbonated Thoughts" Visualization
I stated, "Imagine a glass of carbonated water with lots and lots of bubbles. See the bubbles float to the surface and burst. As the bubbles burst, let go of any thoughts bouncing around your mind along with them. As you continued watching the carbonated water, see the bubbles slowly declining in frequency, getting fewer and fewer, slowly, very slowly, until the water becomes very clear and calm. As the bubbles burst and disappear, continue seeing your thoughts flow from your mind, gradually and slowly becoming less and less, and feel your mind becoming calmer and clearer, coming to a place of complete rest in quiet peacefulness. See yourself drifting into a deep, calming relaxation as you continue to breathe very slowly."
I provided Carla with a tape of this visualization, as well as progressive relaxation and relaxation breathing exercises, for her to take home.
During the first few weeks, John was able to fully explain to Carla the insecurities concerning handling such a small baby that were behind his reticence to provide physical care. Carla expressed similar anxiety. I reassured Carla that she was doing well, and selected several books to provide to Carla and John concerning caring for a premature infant so that they would be able to discover together the reality of the situation.
#4 - Anticipatory Planning
Finally, I emphasized that the couple should make a concerted effort to spend alone time with their two year old daughter. Out of necessity most of the Carla and John’s attention had been spent on the new infant. However, I reminded the couple that this was a stressful time for their daughter, too, and she would need to feel included.
Think of your Carla and John. What strategies would you suggest in handling the crisis precipitated by the birth of their premature infant?
On this track, we have discussed four concepts regarding therapeutic crisis intervention in the case of a premature birth. These four concepts are four tasks for the mother of a premature infant, assessing the family, interventions, and anticipatory planning.
On the next track, we will discuss four concepts regarding therapeutic crisis intervention following divorce. These four concepts are, tasks of engagement, subphases where a crisis is most common, risk factors for divorce, and a case study of an intervention with a client in crisis precipitated by divorce.
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