Crisis:
1. an emotionally significant event or radical
change of status in a person's life
2. an unstable or crucial time or state of affairs
in which a decisive change is impending;
especially one with the distinct possibility of a
highly undesirable outcome
3. a situation that has reached a critical phase
Focus in counseling intervention:
Connection
Stabilization
Awareness and use of coping skills to return to
pre-crisis coping
Awareness and use of social resources to gain
equilibrium and function
Examples of Crises (Where One Might Use Psychological First Aid)
Crisis Intervention
Marie has just come to the domestic violence shelter as a “walk-
in” appointment. Marie left her abusive husband two months
ago and is now living with her sister. She has not had contact
with the shelter in three months. Marie has just learned that
her husband is filing for sole custody of their children (ages 3
and 5). She is panicked as she knows that her bouts of
depression and anxiety may be made public during the court
hearing and she is afraid of losing custody of her children to
her husband. She is not thinking clearly and she is not sure
what to do at this time. She has racing thoughts and reports
that she is having trouble breathing. She is meeting you for
the first time as the counselor she normally meets with is on
maternity leave.
Crisis occurred because it disrupted a If unsuccessful, may try
person’s or family’s usual way of new coping skills (healthy
functioning or unhealthy)
Disequilibrium occurs.
Strong emotional reaction to crisis: Unsuccessful resolution of
confusion, vulnerability, anxiety, emotional state,
powerlessness, hopelessness, etc. maintaining disequilibrium
– more emotion, tension
increases, and
Normal coping skills repertoire: disorganization increases.
Talk to friends, emote, physical activity,
prayer, enjoyable activities, etc.
Psychological First Aid and other crisis models help to
mobilize and enhance the coping skills early. Identify
high-risk individuals and provide referrals for more
ongoing counseling and assessment for psychotropic
medications.
Crisis Intervention
Guiding Thoughts for the Counselor:
1. What can be accomplished in the time
I have with the client?
2. How am I contributing to or influencing
a calm environment for the client? (I
am in ventral vegal?)
3. Assess own breathing and grounding
4. Allow time for the crisis – work at the
client’s pace
5. Relate, Regulate, Reflect
6. Attention, Acceptance, Appreciation,
Allowing
Psychological First Aid is a framework for crisis intervention that is
evidence informed and designed to:
1. Provide compassionate, caring support from a responder
2. Reduce initial distress caused by a crisis or traumatic event
3. Assist people with current needs
4. Promote adaptive functioning (short term and long term coping)
5. Reduce risk and increase resilience
6. Avoid re-traumatization (this model never requires a person to share
the details of his/her/their trauma.
Use of this model is akin to triage in an emergency department where
information is gathered to develop an assessment of a person’s
concerns, needs, coping mechanisms, and existing resources.
• Early assistance
• Reduce distress
• Development of a plan for immediate coping
• May be adjusted (language) for various developmental levels
• Culturally informed and flexible
Formal Uses of PFA _____________________________Informal Uses of
PFA
Incident Command System (Red Cross) Individual application
Red Cross Incident Command, Hurricane Harvey, Houston, TX 2017
1. Contact and Engagement
Goal: To respond to contacts initiated by survivors, or to initiate
contacts in a nonintrusive, compassionate, and helpful manner.
2. Safety and Comfort
Goal: To enhance immediate and ongoing safety, and provide
physical and emotional comfort.
3. Stabilization (if needed)
Goal: To calm and orient emotionally overwhelmed or disoriented
survivors.
4. Information Gathering: Current Needs and Concerns
Goal: To identify immediate needs and concerns, gather
additional information, and tailor Psychological First Aid
interventions.
5. Practical Assistance
Goal: To offer practical help to survivors in addressing immediate
needs and concerns.
6. Connection with Social Supports
Goal: To help establish brief or ongoing contacts with primary
support persons and other sources of support, including family
members, friends, and community helping resources.
7. Information on Coping
Goal: To provide information about stress reactions and coping to
reduce distress and promote adaptive functioning.
8. Linkage with Collaborative Services
Administering Psychological First Aid:
Make contact: Establishing relationship and
connection (verbal and nonverbal means) Introduce
yourself.
Begin triage for level of psychological distress
Ensure safety: Assess environment, provide basic
comforts (Water, warmth, sitting down) and verbalize
your intent to keep someone safe
Stabilize Affect: Evaluate your own affect and
physiological arousal (ventral vagal?), Use basic
counseling microskills/active Listening to give the
client space and support for their emotions, validate
the client’s emotions (Client may be in sympatheic
part of autonomous nervous system)
Understand Immediate Needs and Concerns:
What specific needs and concerns does the client
have right now? (food, shelter, transportation,
clothing, communication with others)
What vital information does the client need?
Listen for the beginning of a plan of action. Think
about writing down client ideas to help you both
organize them as the client gets calmer and more
action oriented.
Allow temporary dependence on you – especially if
the client is emotionally dysregulated. You are
serving as an external support for regulation and
may need to be a bit direct with questions, etc.,
depending upon client’s capacity for functioning.
Offer Practical Assistance: Assist with needs that you
can address right away. Ask the client about how they
believe some immediate needs can be resolved. Empower
the client as much as possible while being active in
providing support.
Facilitate Connections (Social Support) Who does the
client typical rely upon when faced with a problem or crisis?
Does the support system know about the situation?
Facilitate Use of Coping Strategies: What does the
client typically do to take care of themselves when
distressed or in a crisis? What coping skills might be used
right away? What are the additional coping skills that are
needed due to the crisis state?
Compliment what the client has done well (e.g.
strengths)
Create linkages with needed collaborative resources
Failed Recovery From Crisis Natural Recovery in Support
System
(Increases likelihood of a trauma
or stressor related diagnosis or Survivors allowing
other diagnosis) themselves to think about
the trauma
Avoid thinking about and
talking about the trauma Talking with supportive
Dismiss or suppress trauma people about the trauma
related emotions
Do not return to regular, pre- Allowing trauma-related
trauma daily routines and emotions to be fully felt
functioning
Change habits and behaviors Approaching situations and
to avoid trauma reminders stimuli that are reminders of
Refusing or not having access the trauma without avoiding
to help or support or escaping
Attunement:
Supportive reaction to a person’s
emotional needs and moods
Being aware of and responsive to
another
Accurately read another’s cues and
respond appropriately
1.being sensitive to and identifying
with the other person’s
sensations, needs or feelings
2.communication of that sensitivity
to the other person
3.create two-person connection
through reciprocal affect and
resonating response
Critical Incident Stress Management: (Roberts,
2000)
A 7-stage group approach to be used with
individuals who have been affected, to deal
with their thoughts and feelings in a controlled
environment:
(a) Introduction phase—designed to establish
guidelines
(b) Fact phase—descriptions of the facts
(c)Thought phase—express their first thought
or most prominent thought concerning the
disaster
(d) Reaction phase—the most emotionally
powerful of all phases
(e) Symptom phase—moving individuals from
emotional to the cognitive material
Stage One:
Critical Incident Stress Format/Rules: Taking Turns
Management: (Roberts, Confidentiality
2000) Norm that everyone will
A 7-stage group approach speak – provide specific
to be used with voluntary prompts
individuals who have been a. Name
affected, to deal with their b. Role
thoughts and feelings in a c. Where you were when
controlled environment the incident happened?
Individual interpretations
Psychological First Aid are expected
1-3 hour group session Stage Two:
Share thoughts
Two facilitators – content
and process balance Stage Three:
(a)For you personally what
1- 10 days after acute was the worst thing?
stress incident, (b)If you could change one
Sometimes later for mass thing what would that
disaster (Maslow’s be?
(a) Introduction phase— Stage Four:
designed to establish Ask group members for
guidelines specific recollections regarding
(b) Fact phase— cognitive, physical, behavioral,
descriptions of the facts or emotional experiences
(c)Thought phase—express
their first thought or Stage Five:
most prominent thought Education about normal
concerning the disaster reactions and symptoms
(d) Reaction phase—the experienced by trauma
most emotionally survivors
powerful of all phases Identification of specific coping
(e) Symptom phase— skills
moving individuals from Identification of symptoms that
emotional to the indicate PTS (normal reactions
cognitive material to trauma)
(f)Teaching phase—very
cognitive, where Stage Six:
symptoms are Questions and answers
normalized and stress Education regarding additional
management skills are coping skills
