Personal & Family Crisis
Karen has been a therapist with the Family Counseling Center for over 25 years. She specializes in treating depression, anxiety, the many causes of stress and a variety of mood disorders. She offers therapy for couples, dating relationships, parenting, adopted children, teens, care of aging parents and grief. Her expertise also includes supporting personal goals for weight loss, health improvement, self-esteem, and habit change.
What is a Crisis?
A crisis is defined as an acute emotional response arising from one’s inability to cope by means of one’s usual problem solving devices. Events do not cause crisis, crisis occurs when our interpretation of an event, our coping ability, and available resources lead to such a severe level of anxiety that we cannot find relief.
This type of anxiety leads to specific outcomes:
- Emotional – fear, shame, guilt and/or anger. All emotions which disrupt clear thinking.
- Cognitive – distorted thinking and reduced problem solving.
- Biophysical – sickness, disease and metaphorical symptoms of internal pain.
- Social – changes in normal patterns.
Crisis resolution will occur with or without effort to one’s self or others. Crisis originates from three areas: situations, transitions and society. Crisis always involves loss. Therefore, crisis intervention always involves grief work but should also include intervention aligned with its cause. For example people in Utah have died because of nuclear testing in Nevada, which involves loss. However grief counseling would not be as effective as grief work with some political/ legal support.
Four Phases of Crisis
Phase One: An event causes an initial rise in anxiety and the person responds by using their socially acceptable strategies.
Phase Two: The usual strategies do not work and there is a feeling of greater anxiety. Mild Physical symptoms emerge and a person’s coping responses kick in such as avoidance, denial and blame. The person then feels the desire to end whatever is causing such strong anxiety.
Phase Three: The anxiety cannot be ignored. The person becomes increasingly self-centered. New coping strategies are sought out and used and might include socially unacceptable, if illegal, tactics.
Phase Four: The person is now in active Crisis. He or she has no perceived internal strength or social support and the problem remains. There is no hope for its resolution and their anxiety is unbearable. Primitive neuro-systems begin to take over. Problem solving has switched to problem resolution at all cost.
If a person thinks they resolve the crisis on their own (even if that is asking the right person for help), they earn strength and confidence to resolve future crises. A person knows when they were not up to the task at hand and were rescued by someone else. When this happens they remain weak and fearful and may rely upon other, less desirable, alternatives for future problems.
The Crisis Plan
It is important to establish guidelines during a crisis, even if it involves an entire family. Such a plan is usually made with the symptom bearer so the person is in charge of his or her life and plan. In order to be effective, the guidelines must:
Be developed with the person in crisis: The person will then know that they were able to move their plan, live through their crisis and move forward in their life.
Be focused on a concrete immediate problem: Identifying and letting the person know you know what the source of their pain is begins the process of resolution.
Be appropriate to the person’s functional level and needs: This means the person’s helpers we will find the balance between independence and dependence for this person.
Be consistent with the person’s family culture and lifestyle: A plan must be familiar enough for the person in crisis to be able to function properly during and after the crisis and feel supported by their family.
Must include all significant others and the complete social network: We are social beings. All crisis involves loss of some kind of relationship and often a crisis is exacerbated by the perception of being alone and no longer wanted.
Be realistic, time limited, and concrete: It is comforting for people in crisis to be realistic about their available resources, what their responsibility is, that they can do it and what they can expect from you and others.
Dynamic and negotiable: A dynamic plan can be used as a tool to motivate, measure, reduce anxiety and instill new strengths. Like anything alive, the plan must be nurtured and re-evaluated to work properly.
Follow-Up: This element and the one preceding it are usually the responsibility of you the worker to include in the plan, and to initiate action when needed. If you do not place it in the plan, it will usually not be done.
The basic goals of grief work are to help the bereft to accept the pain of loss. Knowing the pain that comes with grief can bring intense and sometimes conflicting feelings. Grief work also makes it possible for the grieving person to be able to healthfully express their feelings through words and tears.
There are simple ways that you can help someone who is grieving a loss. It is important to listen, encourage and allow them to openly express their feelings. Help that person understand the nature of crisis so that they do not place blame, develop destructive personal behaviors or deny responsibility. You can help the person accept reality by helping them realize they survived and have learned things and acquired new strengths that can help themselves and others. Help the person know their strengths and most of all that they are supported through their process.
Developmental Stages for Children in Grief
Infants 0-1 Year Old: Babies can miss and yearn for the sound, smell, sight or feel of their mother or primary care-giver. Babies who are grieving may become agitated and rock, thrash, cry or knock their heads. They may have difficulty eating and sleeping and may become sick with colds or indigestion.
How to Help: Give them a lot of nurturing, physical contact and reassuring attention. Maintain a baby’s routine for their physical needs; i.e. feedings, sleep schedule, walks and play time. Hold the baby gently while it is agitated and crying. While the baby cries, soothe it with the tone of your voice. Let the baby cry until it is finished and comes to a place of peace.
The Young Child 2 -5 Years: A young child understands the profundity of death when someone close to them has died even if they do not understand what death means. Include a young child in the processes surrounding a death in the family and keep him or her close.
How to Help: Use simple, truthful words about the death with the young child. Allow them to ask questions over and over as best as you can. When you do not know the answer, say so. Allow the child to make choices to be involved in the dying process, the viewing, the service and any other opportunity to learn about what has happened. It is important to maintain structure and routine so they have a sense of security throughout the process. A child may have night sweats and scary dreams from which they may wake up crying. Hold them and let them come to his or her own conclusion of the tears. A child may re-enact aspects of the death in his or her play. Allow for this and perhaps encourage the play by joining in. A child’s play is a child’s way to communicate thoughts and feelings. Tolerate a child’s temporary need to become “younger.” A child may lose ground with potty training or may return to sucking fingers/ pacifiers. They may become clingy or want to sleep with others. Allow for this process and, when it is time, gently challenge the child to regain lost ground. Recognize that children’s anger and sadness over daily frustrations may be more intense because of their grief. Provide him or her with outlets for the energy of their grief; i.e. active play, throwing pillows, yelling and sports. Children have a wonderful sense of taking breaks from grief. Learn from them and try to do so yourself.
The School-Aged Child 6 Years to 10 Years: A school-aged child is still a very physical creature and processes the important events of their life through the body and their play. Yet language is growing as a tool for the expression of feelings and gaining of understanding.
The family is the basis of security for a school-aged child and the major environment in which the child learns how to grieve and express their grief. However, peer relationships and the school environment are important influences in a child’s discovery of his or herself.
How to Continue to answer the child’s questions honestly and repetitively. Offer to include the child in the significant processes surrounding a death in the family. Always ask the child if he or she wants to be involved in these processes and how. Clarify when a child’s confused thinking inhibits their understanding of death. It is important that you help them understand that:
- Death is not a punishment for their bad behavior.
- Death is not a monster that comes to get you.
- Death is not something that usually happens again and again if it has happened once in a family (be careful with this one).
If need be, lower your expectations of the child at school since grief takes tremendous physical and emotional energy. Work with school officials to tailor a child’s workload. Read books out-loud with them that have stories about grief. Encourage active play in order to lessen the child’s anxiety and physical tension as a result of grieving. Create a big energy corner of your house for the expression of the big energy of grief. Encourage art, music, dance, singing, crafts and other expressive processes. Share your grief with them since they can learn from your behavior. Do not share your grief with a child if you need the child for your support. Seek your support from other adults. Find peer support groups for your child and for you.
The Pre-Adolescent 10 to 13 Years: Language plays more of a role in the pre-adolescent’s grief, although the non-cognitive processes are still a primary source of integration. The pre-adolescent swings back and forth between their family and peer relationships for his or her primary source of support. Emotions are heightened in the pre-adolescent’s life by the onset of puberty.
How to Help: Expect a child of this age to be in battle with his or her emotions. Respect this child’s efforts to control or conceal their vulnerability and though you should make yourself available, don’t push them. Expect that the pre-adolescent may feel physically ill with symptoms such as headaches, stomachaches and/or colds. Encourage peer relationships and involvement. Look for peer support groups and answer their questions honestly and thoroughly. Be as detailed and scientific as you know how if the child asks for information and encourage them to participate in physical activities.
The Adolescent 13 to 19 Years: The peer group is the primary source of support for a grieving teenager. The family remains a significant resource but the teen is ambivalent about dependency on the family as he or she is asserting their independence. At this stage, teens are developing their reasoning powers and use discussion as a primary form of learning. Discussion helps them process the significant events of their lives and they are beginning to consider concepts such as death in a more philosophical way rather than as a personal assault.
How to Help: Be honest with them with the information you give them and your own feelings about death. Be available to the teen for discussion and expression of feelings, even if you are not taken up on it. Remind the teen of your availability at regular intervals. Expect to hear a teen discuss the death amidst larger issues such as the meaning of life, the unfairness in the world, etc. Encourage peer support for the teen and expect that you may not know much about what they are processing about the death. Allow them to demonstrate their defensive behavior in hiding their grief as long as it doesn’t harm them or others. Expect that them to exaggerate the importance of the person who has died. Their strong feelings may seem out of proportion but allow for and accept these emotions. Encourage a teen to have relationships with other adults. Expect periods of prolonged sleeping and inactivity as well as periods of highly charged and frenetic behavior. Expect that their eating habits will fluctuate and provide them with a structure for eating appetizing foods. Provide them with assistance to get involved in physical outlets for his or her grief like sports, dancing, working out, etc. Also help them get involved in expressive outlets for their grief such as choir, drama, crafts, etc. Watch for drug and alcohol use and get professional help immediately if you suspect it.