Crisis Intervention

From Dass-Brailsford, 2007.

What is Crisis Intervention?

Crisis: A problem that a person cant solve.

Characteristics of crisis:

The event precipitating the crisis is perceived

as threatening.

There is an apparent inability to modify or reduce the impact of stressful events.

There is increased fear, tension, and/or confusion.
There is a high level of subjective discomfort.
A state of disequilibrium is followed by rapid transition to an active state of crisis.
Examples of Crises?

An accident (automobile or in home)

Death/loss of a loved one

Natural disaster

Physical illness (self or significant other)

Divorce/separation

Unemployment

Unexpected pregnancy

Financial difficulties
Difference between crisis and trauma?

Many crises become traumas

Most traumas begin as crises

We try to provide support to prevent crises from becoming traumas

Often we will deal with people and situations with a long history of trauma

In this course we will talk about both, crisis and trauma

Emphasis on prevention, support, and intervention at any stage

PTSD and Complex Trauma
A Holistic Perspective Based in Aboriginal Psychotherapy
Post Traumatic Stress Disorder

The many symptoms of PTSD (perhaps better-called Post Traumatic Stress

Response) fall into 3 main categories. These are called Hyperarousal, Intrusion,
and Constriction.

Hyperarousal reflects the persistent expectation of danger.

Intrusion reflects the indelible imprint of the traumatic moment.

Constriction reflects the numbing response of surrender.

Traumatic events overwhelm the ordinary systems of care that give people a sense of
control, connection, and meaning (Herman, 1997).

Intrusion/Reexperiencing

1. Intrusive imagery
2. Flooding
3. Hallucination
4. Dissociation (Flashbacks)
5. Anniversary reactions
6. Unconscious behaviour/re-enactment
7. Intensification by exposure to
Avoidance and Numbing
1. Restricted affect
2. Detachment, isolation, withdrawal, estrangement
3. Amnesia, impaired concentration
4. Loss of interest in meaningful activities
5. Developmental arrestation
6. Sense of foreshortened future
7. Depressed affecttrauma-related
Physiological Hyperarousal
1. Exaggerated startle response
2. Affective hyperarousal

stimuli/ideation

3. Frenetic activity
4. Sleep disturbance
5. Hyper-vigilance and scanning
6. Sensation seeking
7. Pronounced activity to stimulus with trauma association

Dimensions of Trauma
1.Bereavement/loss
2.Imminence/Potential for reoccurrence
3.Duration/Severity
4.Displacement
5.Exposure to death/dying
6.Moral conflict
7.Role in Trauma
8.Location
9.Life threat
10.Complexity of stressor

COMPLEX TRAUMA

Impairment of affect regulation

Chronic destructive behaviour (Pathological self soothing)

Self- mutilation

Eating disorders

Drug and alcohol abuse

Secret lives: re-enacting, esp. in sex

Amnesia and Dissociation

Somatization

Alterations in relationship to self and Distorted relations with others

Relationships to self and others as fragmented as trauma memories

Unable to negotiate a mutual relationship

Loss of Spirituality

Life centred around hurt

Self-Care for Professionals Working

with Traumatized Populations

Vicarious and Secondary Trauma

Individual Symptoms:

Intrusive imagery or thoughts

Shifts in frames of reference

Troubles with feelings about self and others

Organizational Symptoms:

Reduced commitment and motivation

Cynicism/pessimism

Ethical and boundary issues

Staff turnover

Cost increases due to theft

Strategies for Self-Care

Physical exercise

Fun, non-traumatic material

Mutually supportive and fun friendships

Spiritual connection (in the broadest sense)

Complex Trauma and the Brain
A Holistic Approach
With acknowledgment of the work of
Shirley Turcotte, MA, RCC

The brain is an information center that is capable of receiving, sitting with,

processing and moving beyond trauma, whether it is experienced mentally,
emotionally, physically and/or
spiritually.
Neuroscience and imaging technology can now demonstrate

through research what Indigenous peoples have known for millenia:

the human mind and the human body are intimately connected to
and affected by one another.

The Anatomy of the Brain

The Amygdala

Checks the emotional content of experience and decides whether the flight, fight or
freeze response is required

Registers everything physiologically around an experience

Unable to differentiate real and imagined danger

Central to the immediacy of fear and to the memory of it

Regulates body functions (heart rate, blood pressure, body temperature)

Remembers threats and applies the lessons contained in these memories to

future circumstances, while generalizing fearful experiences to as many situations
as possible

The Hippocampus

Constantly remodels in response to new details, and will easily learn to

differentiate memories

Plays an important role in connecting, categorizing and organizing different

aspects of a memory

Is thought to be responsible for locating the memory of an event in its proper time,
place and context
Checks with the amygdala about the emotional content, if comfortable, sends info
to the cerebral cortex
If content is traumatic, the memory may be fragmented and stored with some
pieces in the body, some as emotional memory, and other pieces get lost and are
not stored at all
Neutral Experiences and the Brain

If amygdala is in resting state, hippocampus sends info to be stored in cerebral

cortex

Memories are autobiographical; they include a sense of time and self

Traumatic Experiences and the Brain

Overwhelm the brains capacity to process information

Trauma can shut down the hippocampus, so that charged sensations and
experiences flood the amygdala and are laid down as implicit memories- blocked
from becoming explicit

Damage to the hippocampus, which processes memory, may explains why

survivors of trauma often seem to have incomplete or delayed recall of their
experiences
When amygdala is agitated, hipocampus may not send info to be stored in cerebral
cortex

Narrative memory becomes fragmented

Fragments are stored in body, as emotional memory, and some pieces are lost

Mirror Neurons

-a spindle cell - a different variety of brain cell plentiful in humans

-sense both the movement of another person and their feelings, preparing us to
imitate the movement and feel with them
-reflect back an action we observe in someone else, making us mimic or have the
impulse to do so.

-make emotions contagious, letting the feelings we witness flow through us,
helping us get in sync and follow whats going on. We feel others emotions,
movements, and sensations.

How is this information helpful for our clients?

communicate with clients about their struggles in an objective and non-shaming

manner

neuroscientific perspective to lets us talk with clients about how brains function
generally, instead of the problem with theirs

brain is able to regenerate, is more resilient and has more plasticity than we once
believed

Direction from calming prefrontal cortex can help the agitated amygdala

Emotional memories are thought to be relatively indelible, but their expression can
be modified by feedback from the prefrontal cortex

Finding the Right Fit

Client-centred and therapist-driven: working with clients where they are

It takes time to unravel memories

As survivors we can never remember what never registered

The body keeps trying to get attention, to tell what happened

Once the story fits and the client accepts it,

the body feels better

Affective releasing- consolidation- closure

The body of knowledge around the brain, storage of memory, and trauma is
constantly growing and changing. Its a good idea to hold the facts we have
tentatively, especially when it comes to prognosis for recovery of trauma
survivors. We dont want to contribute to the societal conditioning that says
that trauma survivors are broken.
Shirley Turcotte

Bidermans Chart of Coercion

General Methods, Effects, and Purposes

1. Isolation : Deprives victim of all social support for the ability to resist; develops an
intense concern with self; makes victim dependent upon interrogator.

2.Monopolization of Perception: Fixes attention upon immediate predicament; fosters

introspection; eliminates stimuli competing with those controlled by captor.
3. Induced Debility and Exhaustion: Weakens mental and physical ability to resist.
4. Threats: Cultivates anxiety and despair.
5. Occasional Indulgences: Provides positive motivation for compliance.
6. Demonstration Omnipotence: Suggests futility of resistance.
7. Degradation: Makes cost of resistance appear more damaging to self-esteem than
capitulation; reduces prisoner to animal level concerns.
8. Enforcing Trivial Demands: Develops habit of compliance.