On the last track, we discussed 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.
On this track, we will discuss maturational crises. I will describe for you the ‘Essential vs. Nice’ technique I used with a 72 year old client, Harold.
On the last four tracks, we have discussed therapeutic crisis interventions in situational crises. However, as you know, a client’s crisis may be precipitated not only by a situational change, but also during periods of great social, physical, and psychological changes during the normal growth process. A client may become aware of increased feelings of confusion.
I find that when a client experiences a crisis during one of these transitional periods, it is important for me to assess what part of the precipitating factors are related to the client’s maturational stage, and what is the result of his or her stressful event in the client’s current social orbit.
Harold, 72, entered a crisis state after his wife, Greta, suffered a bad hip fracture. Greta’s healing process had been slow, and she had required inpatient stays for rehabilitation for periods of over a month at a time. Harold stated, "Our plans for retirement were made for us, together, not just one of us, alone!" Harold had concealed his feelings of fear and anger from Greta, and had instead manifested severe insomnia, anxiety, and guilt over his inability to speed Greta’s recovery.
Harold felt anger towards Greta since her impairment threatened their ideal future, but he had overprotected his wife from those feelings rather than expressing them. In his crisis state, Harold had trouble perceiving Greta’s illness as anything other than the beginning of a final loss of Greta from his life. Moreover, Harold stated, "If I were a better husband, I’d have been able to help Greta get well faster. But now I’m getting so damn old I can’t do the things I used to, and that’s ruined things for both of us!"
Technique for Social Work CEUs, Psychology CEUs, Psychologist CEUs,
Counselor CEUs, Addiction Counselor CEUs, and MFT CEUs
Technique: Essential vs. Nice
In our first session, I introduced the Essential Versus Nice technique to help Harold refocus on his capabilities as a loving, caring husband, rather than on the tasks he felt unable to accomplish due to his age. I had Harold first write a list of the tasks he thought a husband should be able to do. Harold’s stated, "well, I think the three most important things are to love, honor, and cherish. That’s what I promised in our vows, and I stand by that." Harold’s list also included listening, fixing broken appliances, keeping the car running, mowing the lawn, and taking care of Greta and the house when she was sick.
Next, I asked Harold to take a sheet of paper and write the word "Good husband" across the top. I then asked Harold to draw a line down the middle of the sheet to make two columns. Across the top of one column, he wrote "essential", across the top of the other Harold wrote the word "nice." I stated to Harold, "I’d like you to take another look at the list you wrote. Think about which of these things are essential for you to be a good husband, and which are just nice or helpful." Harold quickly placed love, honor, cherish, and listening under the "essential" column.
After thinking for a while, Harold decided that some of the more physical tasks, such as fixing appliances and mowing the lawn, belonged under the "nice" column. Harold stated, "I still think those tasks are important. But I if you’re asking me what’s absolutely essential to being a good husband… I guess it looks like I can still do all of those things after all."
Would the Essential vs. Nice technique help your Harold recognize that he or she can still fulfill the essential tasks of his or her role, even if they cannot do everything they used to?
My intervention with Harold also focused on helping Harold reestablish communication lines with Greta, as well as on helping Harold reestablish ties with the couple’s old friends. Harold had cut himself off from these friendships in order to give his full attention to trying to care for Greta, and thus found himself without social support in her absence. I encouraged Harold to role play and rehearse expressing his feelings of fear and anger to Greta.
In addition, I asked Harold to write a list of supportive friends who he had been close to before Greta’s accident. We agreed that Harold would make an effort to contact one of these friends once per week, even if the contact only took the form of a social phone call or letter.
Additionally, we explored Harold’s feelings concerning the possibility that Greta would be unable to return to her previous level of physical functioning. Harold became able to consider alternative modes of life for the two of them, even to the point of considering selling their two story home so that Greta would not need to climb stairs.
Think of your Harold. What aspects of the transitional period of old age contributed to his crisis?
On this track, we have discussed maturational crises in four transitional periods. These four transitional periods are young adulthood, adulthood, late adulthood, and old age.
On the next track, we will discuss four stages of burnout, and therapeutic crisis interventions for clients experiencing burn out. The four stages are stagnation, frustration, apathy, and hopelessness.
Peer-Reviewed Journal Article References:
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.
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.
Mazzer, K., O'Riordan, M., Woodward, A., & Rickwood, D. (2021). A systematic review of user expectations and outcomes of crisis support services. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 42(6), 465–473.
Robinson, O. C., & Smith, J. A. (2010). The stormy search for self in early adulthood: Developmental crisis and the dissolution of dysfunctional personae. The Humanistic Psychologist, 38(2), 120–145.
Online Continuing Education QUESTION 13
If a client present during a transitional period, what is it important to assess?
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