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Barry Greenwald, Ph.D.

It is easy to think that there are a class of events that can easily be defined as crisis. Thus, such events as earthquakes, fires, murders, rapes, and disasters are easy candidates for the category of crisis. While this is certainly true and we should expect people to react intensely to these life-events, we really need a more sophisticated means for understanding the "nature of crisis" and the ways in which people react to them.

We need to understand that people give meaning to the events that happen in their lives. Each of us witnessing or participating in the same event will experience it differently. To a large extent, the difference is attributable to our unique life histories. We understand the new and the novel or the highly emotionally charged in terms of what we have already experienced. We find ways of fitting new experiences into what we already know and that allow a sense of both familiarity and comfort. It allows us to apply tried-and-true coping styles which permits a sense of mastery. In this way "new life experiences" are whittled down to size; their uniqueness is made manageable and not disruptive.

Any life event can take on crisis proportions if it is experienced as sudden, intense, unexpected, or emotionally super-charged. We experience crisis as overwhelming leaving us without means to cope or to adjust. Somehow, we cannot make sense of what is happening or why it is happening. Without answers to those important questions, we are left helpless. We simply do not know what to do to control or master the situation. We do not know how to make it stop. Wave after wave of emotion sweeps over us and we are unable to predict when or if this awful situation is going to end.

Thus any event can be a crisis if it wipes out our ability to make sense out of what is happening. We become bereft of means for exercising some form of control on our lives. We feel helpless; the victim of events beyond reason and certainly beyond our control. It is only after we regain some sense of understanding and some sense of control that the crisis is reduced to something manageable.

What to look for in a crisis call:
The caller is likely to be very upset and disorganized in his/her presentation. Occasionally, a caller will present in a wooden, robot-like manner, devoid of any feelings whatsoever. It is as if the caller has anaesthetized him/herself to all feelings and presents as if they have deadened all emotions.

The caller describes an event that is usually sudden in onset or will describe a situation in which the event was "the last straw" in a series of events that just sent them over the edge.

The caller cannot make sense of or understand what has happened. He or she asks questions such as "Why did this happen?" "Why me?" "It just doesn't make any sense!" "What did I do?" (Sudden deaths, rapes are likely to provoke very clear examples of this type of questioning as the caller tries to make some sense out of an event that makes no sense at all.)

The caller complains of not knowing what to do and expresses a loss of ability. They're not sure what's the matter with them, but they know they are not functioning as well as they usually do, and they don't know what to do about.

The listener experiences very acutely the caller's sense of helplessness and feels a very real pull to intervene actively to take control of the situation.

Some Ways of Handling the Call:
As always, attempt to build a connection with the caller by being as empathic as possible. Sometimes all this requires are comments such as: "Go on ..." "Tell me more ..." "This is very hard for you." "Take a moment to catch your breath, we have the time ... "

If the level of upset is so great that the caller cannot even talk, the listener may want to try to help them calm down with some simple breathing exercises. "Just for a moment, I want to see if we can help you calm a bit. Try breathing in very slowly; now let the air all the way out. Good. Let's try that again." The listeners voice should be slow, calm, and reassuring; gently, but unmistakably in control.

The listener dealing with a person in crisis is likely to have to be more active than in a normal call. Because crisis is so disorganizing, the caller may have great difficulty in telling what happened in a coherent manner. The listener can provide organization to the caller. "How did it start?" "What happened next?" "What did you do?" "How did you feel at the time?" "What happened next?" Essentially, you are providing the frame within which the caller can tell his/her story. You are also breaking the story up into small components which are easier to handle than the whole massive experience.

Follow the feeling tone and mirror it. If necessary, encourage the feelings and their expression. If, however, the feelings are so intense and overwhelming increasing the sense of being out-of-control, help the caller to just describe the events that have taken place without emphasizing the feelings. There will be opportunity to come back to them.

As the story unfolds, try to find out how the person understands what happened. Listen for clues that will link the "current event" with something historical. Often, an event takes on crisis proportions because it revives the memory of some past, unresolved event in which similar feelings were experienced. A current death reminds one of a past death. A failure today reminds one of a failure at some other time.

Try to get a feeling for the person's coping style and what is still working. You will want to provide assistance directly if the person cannot cope for her/himself. But you will not want to take over more than is required. Sometimes, it is just necessary to encourage and reinforce coping styles that are very wobbly. Questions such as: "What do you feel you'll be able to do?" "Is there something you want to do about this?" can provide clues as to how well a person is coping and where you might need to lend your skills to theirs.

Gently educate the person as to what they might expect for the next couple of days during the acute phase of the crisis. Let them know that they're likely to experience a roller-coaster of feelings, and that there could be some rough sledding for awhile. Also let them know that this emotional upheaval is very normal after experiencing such an upsetting event. Encourage them to call back at any time when thing just feel like too much for them.

Make concrete plans with them in a step-by-step fashion and only for the next couple of days. A person in crisis does not absorb a lot of information nor can they foresee to far into the future. Check out the plans that you've made with the caller to be sure that they're well understood. If you have any doubt, ask them to write down what you've talked about as a way of aiding their memory.

In any crisis call, you should listen for and be alert to suicidal potential. If a person is so confused and disoriented by what has happened, they might be a danger to themselves without consciously wanting to commit suicide. If the person appears highly impulsive and reckless, the possibility of suicide, planned or otherwise, should not be ruled out. If you sense that possibility, do not hesitate to bring it up for discussion. You may have to actively encourage the person to seek a safer situation, get some people to be with her or him, or even suggest hospitalization.

Encourage the caller to call back after a few days in order to see how things are going. If the acute phase of the crisis seems to have passed and the caller is markedly more calm, the listener wants to carefully become less active. In essence, as the caller's coping skills return and become functional once again, the listener wants to reinforce them and not simply replace them with the listener's own skills. You want to return control of the person's life to the person.

A crisis can be the tip of an emotional iceberg. As the acute phase passes, the pain diminishes. However, the need for continued psychological work may still be present. The listener should listen for patterns and be thinking about the possibility for a referral for continued psychological assistance.

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