Introduction to Crisis Case Handling
Crisis case handling is considered quite a bit different from long-term counselling or therapy. While the steps might seem to be very similar e.g. (assessment, intervention, and evaluation) the short-term nature of crisis intervention and the goals are quite different. Crisis intervention aims to restore pre-crisis functioning while therapy’s goal is to work towards an even better way of coping.
Principles of Therapy
- Diagnosis: Goal of determining DSM-V diagnostic categories
- Treatment: Exploring the underlying causes of discomfort and behaviour to make long-term changes
- Plan: A comprehensive, personalized approach to accomplish long-term goals
- Methods: Therapy techniques focusing on a mix of short-term, medium-term and long-term goals
- Evaluation: Observation of client’s functioning over several months or even years
Principles of Crisis Intervention
- Diagnosis: Triage to determine immediate risk level
- Treatment: Restoring pre-crisis functioning
- Plan: Focused on restoring immediate short-term issues
- Methods: Time-limited brief crisis and trauma interventions
- Evaluation: Observation of how client’s current function compares to pre-crisis in hours or days
Assessment in Therapy
Many modalities of therapy begin with an assessment stage, where data is collected to give the clinician a deep understanding of the client. This helps in the long-term when the therapist can see a change on specific assessment tools (like the Beck Depression Inventory), or can see the client’s life “come together” and the desired changes occurring.
Assessment in Crisis Intervention
Contrary to therapy, in crisis intervention, the purpose of assessment is focused more on understanding the client’s concerns so that immediate steps can be taken to recover. Extensive paperwork or assessment tools are unlikely to be filled out, with most of the data collected verbally and visually.
Intervention in Therapy
Interventions in therapy include long-term therapies like Cognitive Behavioural Therapy that look at a person’s history of actions, beliefs and cognitions and explores them over a period weeks or months to identify maladaptive thoughts and systematically work to change these.
Intervention in Crisis Intervention
In crisis intervention, the intervention is focused on immediate short-term crisis resolution by providing stabilization, venting, referrals, and in inpatient environments medication. The whole focus of the encounter may be limited to a one hour phone call or a maximum of 72 hour psychiatric stay, so everything proceeds at a much more rapid pace.
Evaluation in Therapy
In therapy, evaluation is the process of determining whether there is a change in the client and whether therapy has “worked.” This is closely associated with the concept of termination, deciding when to end therapy. With psychodynamic therapies, some clients would be in therapy for years. Nowadays, 16-24 sessions (often once a week) is considered a long treatment time.
By observing changes in the client’s behaviours and beliefs over time the therapist will begin to see improvements in their behaviour.
Evaluation in Crisis Intervention
In crisis intervention, evaluation occurs over minutes, hours, or potentially days as you observe whether the client is returning to pre-crisis equilibrium. The goal is not for the client to “get better” but simply to retain enough control over their life that they’re able to function independently.
Crisis case handling is an important skill for crisis workers and therapists alike to learn, because all may experience clients in crises throughout their careers.