Crisis Intervention: Assessment & Practical Strategies

On the last track, we 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 this track, we will discuss crisis intervention following a divorce, and how the three losses of divorce can impact self esteem. I will describe for you the Terrible Name Monitoring technique I used with Yolanda.

Yolanda, 23, was in the process of divorce from her husband.  She had been referred to the crisis center by her attorney.  Yolanda was displaying symptoms of severe depression and anxiety, which had begun three weeks before when Yolanda was notified of the date of divorce proceedings.  She had found it difficult to get out of bed or perform routine tasks, and she had lost her job due to her inability to control her frequent crying spells. 

When I questioned Yolanda about the event, she stated that she had been informed on that date that the only way she would be able to receive alimony is to countersue for divorce.  Yolanda stated, "Something must be wrong with me if I can’t hold a husband!  I still love Jack!  I don’t understand how I could have failed so badly!"  Yolanda was adamant that she did not want the divorce, and the necessity of being an active participant in a divorce she did not want added to the factors that resulted in Yolanda’s crisis state.

Three Losses of Divorce
My early intervention with Yolanda focused on examining her divorce as a traumatic event.  Yolanda’s crisis seemed to center around a large loss of self esteem as a result of her perceived "failure."  I explained to Yolanda that there can be three main losses in divorce that can impact a client’s self-perception.

Loss #1 - Invulnerability
The first of these losses is the loss of invulnerability.  As you are well aware, many clients may feel as though a failed marriage cannot possibly happen to them.  Yolanda had been certain that her marriage with Jack would work.  She expressed feelings that since this marriage, which she had perceived to be ideal, had failed, she was doomed to never have a successful marriage. 

Loss #2 - Orderly World
A second loss of divorce is the loss of an orderly world.  Yolanda believed that if she was a good, honest, and helpful wife to Jack, her marriage was sure to succeed.  The trauma of the divorce had proved to Yolanda that even her best efforts could not prevent what she perceived to be the worst from happening.  Clearly, clients like Yolanda desperately want to believe in a just world where good is rewarded, but they have had experience that contradicts these beliefs.  Do you have a client for whom the loss of an orderly or just world has triggered a crisis?

In addition to the loss of invulnerability and the loss of an orderly world, a third loss of divorce is the loss of a positive self image.  Although supportive individuals like Yolanda’s sister Terry assured her she was a caring, lovable person, Yolanda felt like "damaged goods."  Yolanda stated, "I feel ugly! Ugly like a monster.  My family keeps telling me I’m a good person, but I can’t be!  I’m such a horrible woman men can’t wait to get rid of me!" 

Loss #3 - Self Image
This loss of self image clearly affected all of Yolanda’s relationships.  Yolanda had begun pulling away from even her oldest friends.  She felt that if she could not keep a husband, she would not be able to keep friends either.  Yolanda’s feelings of shame at not being able to sustain the marriage compounded her loss of self esteem.

Technique: Terrible Names
Since it was clear that the loss of self-esteem and self concept were the largest contributing factors to Yolanda’s current crisis state, I introduced the Terrible Names Technique in order to give Yolanda an immediate step in reassessing her own value.

Terrible Names Technique - 3 Steps
Step One: First, I stated, "Yolanda, I heard you describe yourself as ugly and horrible.  I’d like for you to take a few moments and write down some of the other names you call yourself, or terms you apply to yourself when you are thinking about the divorce."  Yolanda wrote for two minutes, and listed several negative terms, including ‘failure,’ ‘crazy,’ ‘hag,’ ‘bad,’ and ‘stupid.’

Step Two: Second, I asked Yolanda to list some of the conclusions she had drawn about herself or her relationships to others following her divorce.  Yolanda wrote, ‘No man will ever love me,’ ‘I will never have a meaningful relationship,’ ‘No one wants to be around me,’ and ‘I will never get to have children.’

Step Three: Next, I asked Yolanda how she would feel if another person called her those names, or spoke to her in that manner.  Yolanda stated, "I’d really hate that.  I’d probably feel awful."

Technique: Terrible Name Monitoring
To assist Yolanda in realizing how her own negative self-talk contributed to her depression and her crisis state, I asked Yolanda to monitor her negative self talk over the next two days using the Terrible Name Monitoring Technique.  I stated to Yolanda, "Every two hours, start a blank sheet in your journal.  Write down the date and time, and then keep a log of all of the negative things you telling yourself. 

If you can, include what happened that brought up the negative images.  After you finish an entry, take some time to think about how these statements help you create a negative image of yourself that make you feel alienated from your friends and family."

In our next session, I discussed Yolanda’s journaling results with her.  Yolanda stated, "I’m really shocked by just how much I’ve been putting myself down.  The list of names I’ve been calling myself is huge!  Some of them are names I’d never dream of calling someone else.  I also noticed that every time I start in on myself, that’s when I feel like just going back to bed.  I didn’t realize that before."

Reframing
To help Yolanda continue her progress, I asked Yolanda to repeat the terrible name monitoring technique for two more days.  This time, I asked Yolanda to reframe each negative name or self-statement into a positive self-statement.  I practiced this reframing with Yolanda by focusing on one of her most prevalent negative self-statements.  Yolanda stated, "I almost always seem to come back to ‘no man will ever love me,’ and as soon as I think that, I just want to go to bed for the rest of my life!" 

I suggested that one way Yolanda could reframe the negative self statement ‘no man will ever love me,’ would be to write, ‘Things did not work out with Jack, but that does not mean I am unlovable.  It just means that things did not work in that one relationship.  I stated to Yolanda, "It may feel like you have to force yourself to write positively at first, but keep practicing.  Even though you may not feel positively now, as you practice these positive statements, you may notice that you start to believe them." 

Think of your Yolanda.  Would the terrible names monitoring technique help him or her?

On this track, we have discussed crisis intervention following a divorce, and how the three losses of divorce can impact self esteem.

On the next track, we will discuss maturational crises in four transitional periods.  These four transitional periods are young adulthood, adulthood, late adulthood, and old age. 

Online Continuing Education QUESTION 12
What are the three losses of divorce? To select and enter your answer go to CEU Answer Booklet.