Cultural implications of crisis intervention.

Elements and components of crisis situations are identified. Strategies and sequences of crisis intervention are described. Cultural implications of crisis intervention are discussed.

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A crisis event is seldom anticipated. By its very nature, a crisis represents an unanticipated event during which coping mechanisms are temporarily compromised and adaptive living is jeopardized (Caplan, 1964). Personal crises may stein from sudden life-affecting events or from a combination of accumulated problems. However, a crisis is a critical phase in one's life during which normal ways of dealing with the world are suddenly interrupted (Lewis, Lewis, Daniels, & D'Andrea, 2003). Typically, responses to a crisis are time limited, yet may persist into symptoms of acute stress or post-traumatic stress.

Crises are universal in nature and affect people from all cultures. Sources of crises are remarkably universal across cultural groups, and include such events as natural disasters, domestic violence, sudden change in marital status, death of a loved one, medical emergencies, loss of occupation, assault, and burglary.

Despite the universality of crisis provoking events, culture plays a strong role in how crisis is interpreted, both for the crisis intervener and the crisis victim (Pederson, 1987). Culture can influence how a provocation is interpreted and the meaning attributed to that provocation. Culture can also influence how individuals and communities express reactions to crisis provoking events. While reactions to crisis situations seem to be common throughout all cultures based upon the physiology of human beings, manifestations of responses may differ significantly. In this regard, culture forms a context through which individuals and communities view and appraise their own responses.

Culture also affects the responses of others to the provoking events, which is a critical issue for the crisis victim. In this regard, if people think that the society surrounding them will not accept them as victims, there is a tendency to withdraw, retreat and become silent. Indeed, if one's own culture, or the culture in which one exists, either rejects or stigmatizes a crisis victim, the victim experiences additional injury to the provoking events.

However, cultures can comfort the victim and aid the recovery process. Cultures may help define the pathways to healthy adjustment and may contribute to new lives constructed by victims after a traumatic event. The routines and traditions of culture ]nay aid survivors of a tragedy in regaining an orientation and making life predictable.

Each crisis situation is different, and can vary across a number of domains (James & Gilliland, 2001). A developmental crisis is associated with a sudden change in growth and development. Graduation from school, the birth of a child, or a career change exemplify antecedents preceding a developmental crisis. An existential crisis is associated with a reassessment and reflection upon the meaning and purpose of life, and may accompany a developmental crisis. An environmental crisis occurs when some natural or human-made disaster overtakes a person or group of people. A situational crisis represents an uncommon and extraordinary event for which an individual cannot possibly forecast or control. An automobile accident, a sexual assault, or the sudden death of a loved one exemplifies a situational crisis.

Symptoms of crises vary across individual and presenting circumstance. Typically, responses to a crisis include feelings of fear, shock and distress, which result in a disruption of emotional equilibrium. Symptoms of Acute Stress Disorder may be apparent, including a subjective sense of numbing and detachment, a reduction in the awareness of one's surroundings, a sense of derealization and depersonalization, and an inability to recall important aspects of the precipitating circumstances (American Psychiatric Association [APA], 1994). Consequently, the focus of attention may be directed to the disruption itself, rather than to the precipitating event (Belkin, 1984).

Crisis intervention provides an immediate and temporary emotional first aid to the victim, with specific interventions targeted to the victim and to the circumstances of the presenting problems (Rosenbluh, 2002). To this end, crisis intervention attempts to reduce the level of stress experienced by the crisis victim and to modulate the intensity of stressors operating in the victim's life. Timing is of crucial importance. An immediate intervention is needed to interrupt, reduce or redirect the crisis victim's maladaptive behavior. In this regard, professionals from a variety of disciplines, and non-professionals alike, often provide crisis intervention strategies.

Strategies of crisis intervention are based on psychological theory, yet are adapted and modified to fit the demands of the crisis situation (James & Gilliland, 2001). For instance, the focus of crisis intervention is directed to the person and events surrounding the crisis reaction for purposes of restoring the victim at best to a pre-crisis level of functioning; or in the case of medical emergencies, restoring the victim to a level of normalcy. Intervention is provided in a direct and authoritative manner to maintain adequate control of the dialogue. The range of conversation is usually limited to the presenting crisis symptoms for purposes of managing the immediate demands of the crisis situation. Length of crisis intervention seldom lasts more than a few sessions, with one session often provided. In this regard, crisis intervention is not looked upon as a psychological intervention, although referral to counseling or psychotherapy is often needed.

Given the immediate demands placed upon the crisis intervener, factors of culture and cultural identity are often neglected. Yet. the crisis intervener and crisis victim often come from different cultures, i.e., age, gender, race, ethnicity, language, nationality, religion, occupation, income, education. mental and physical abilities. To this end, crisis intervention often requires an immediate development of trust between two people from different cultures for purposes of restoring the victim's coping mechanisms to a pre-crisis level of functioning. The quick development of rapport and trust between people of different cultures often requires the crisis intervener to communicate, both non-verbally and verbally, a demeanor that one is knowledgeable about and accepting of cultural differences.

The success of developing rapport and trust between people of different cultures requires a look at a number of assumptions the intervener and victim bring into the crisis intervention, and these assumptions may vary across cultural groups (Pederson, 1987). It is often assumed that all people share a common measure of normal and adaptive behavior and that the crisis intervener needs to change the individual to fit the system. It is assumed that a formal intervention is more important than using the victim's natural support system, and that the primary intervention target is the individual rather than a group or organization. It is often assumed that everyone benefits by engaging in linear thinking about events, and that interpretations are best provided by using abstract words giving cause-and-effect explanations. And. it is often assumed that the crisis intervener is aware of his or her own cultural assumptions.

James and Gillaland (2001) discuss crisis intervention as a sequence of six steps across two modalities. A listening modality focuses upon the crisis intervener's ability to (a) define the problem, (b) ensure client safety, and (c) provide support; while an acting modality focuses upon the victim's ability to (d) examine alternatives, (e) make plans, and (f) make a commitment to the plans. Throughout the six steps, crisis interveners continually assess the victim's progress and readiness for change, and do so within a cultural context.

Crisis intervention requires a quick response to events caused by a traumatic event, for purposes of stabilizing a victim to safety; and this intervention involves consideration of a number of guiding principles (Shapiro & Koocher, 1996). First, crisis responses rarely indicate a psychopathology, although specific symptoms may resemble psychiatric reactions, viz., depersonalization, anxiety, and depression. Second, responses to crisis events represent a continuum, with specific victim responses accounted for by available personal and social resources. Third, all crises will affect other areas of functioning, including home, work and school. Finally, the frequency, intensity and duration of aftercare will vary across people regardless of culture.

Given theses assumptions and guiding principles, culturally sensitive crisis intervention requires a quick intervention to assist the victim's control over the presenting circumstances. A first level of intervention requires the establishment of a therapeutic alliance within a safe holding environment in order to assure sufficient rapport for trusting building. Allowing the victim's expression of emotion (viz., fear, anxiety, anger) and communicating an understanding of that emotion assists in developing a trusting alliance. Secondly, universalizing the victim's symptoms provides assurance that these responses are logical end products of antecedent conditions and do not represent a psychopathology. Indeed, individual responses to crisis situations vary on a continuum, with a specific victim's responses explained by the unique individual and social resources available at the time of the crisis. Third, a brief explanation of the purpose of intervention will provide the victim with an understanding that overall goals are designed to restore the victim to a pre-crisis level of functioning. In this regard, crisis intervention is intended to optimize the victim's functioning across all social domains, including home, work and school, and to return the victim to a feeling of normalcy. Fourth, an explanation of and referral to community resources provides assurance that the victim will not be abandoned at the conclusion of time-limited crisis intervention.

Crisis intervention often demands quick responses in a limited period of time. Depending upon the crisis severity, rapid questions and answers are often required to manage the crisis response. Yet, people from many cultural groups look upon questioning as an intrusion into privacy. Therefore, informing the victim of the intervener's need to ask questions can assist people from those cultural groups that questioning in needed as a necessary, yet temporary, strategy to assure victim safety. In this manner, questioning may represent the only expedient manner by which differences in language, customs and behaviors can be addressed and clarified in a timely and expedient manner.

After symptoms of crisis are stabilized and controlled, an acknowledgement of the crisis intervener's appreciation of the victim's culture can assist in identifying cultural resources available to the victim's after-care. In this regard, resources from family. church and ethnic agencies can provide the continuing support needed after symptoms are controlled.

Crisis intervention usually involves quick actions to restore a victim's equilibrium to safe and predicable living. As such, crisis intervention is usually an immediate and temporary intrusion into the life of a person (Rosenbluh, 2002), with referral to after-care remediation if needed. Typically, the focus of crisis intervention is directed to such personality factors as coping mechanisms and individual resilience, as well as to such environmental factors as the sources of emotional support. Yet, the cultural context of crisis events is often neglected, despite the subtle influence of culture upon the appraisal of victims and circumstance. In this regard, helping the victims of trauma requires crisis interveners to become aware of their own cultural assumptions; demonstrate an ability to communicate an understanding, acceptance and appreciation of cultural differences; and identify available resources from the victim's culture to assist with crisis resolution and aftercare.

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

Belkin, G. (1984). Introduction to counseling (2nd ed.). Dubuque, IA: William C. Brown.

Caplan, G. (1964). An approach to community, mental health. New York: Grun & Stratton.

James, R., & Gilliland, B. (2001). Crisis intervention strategies. Pacific Grove, CA: Brooks/Cole.

Lewis, J., Lewis, M., Daniels, J. & D'Andrea, M. (2003). Community counseling (3rd ed.). Pacific Grove, CA: Brooks/Cole.

Pederson, P. (1987). Ten frequent assumptions of cultural bias in counseling. Journal of Multicultural Counseling and Development, 15, 16-24.

Rosenbluh, E. (2002). Emotional first-aid. Retrieved June 16, 2004 from www.emotionalfisrtaid.com.

Shapiro, D., & Koocher. G. (1996). Goals and practical considerations in outpatient medial crises. Professional Psychology: Research and Practice, 122, 109-120.

Bruce F. Dykeman, Associate Professor, Department of Counseling and Human Services. Roosevelt University.

Correspondence concerning this article should be addressed to Bruce F. Dykeman at [e-mail].