Differences in Approaches in Crisis Counseling and Psychotherapy

Differences in Approaches in Crisis Counseling and Psychotherapy

Abstract

This work will respond to questions posed as part of the learning activities in module two. The differences between psychotherapy and crisis counseling will be discussed as it pertains to service provision, techniques, use of assessments, and clinician self-awareness. A brief discussion will summarize the victim-rescuer persecution triangle and how the clinician can keep from becoming enmeshed with their clients. Scholarly articles and class text will academically support the positions taken by this paper.

Keywords: crisis counseling, psychotherapy, assessment, victim, rescuer, client, clinician.

Differences in Approaches in Crisis Counseling and Psychotherapy

Crisis intervention brings to mind several things that can produce powerful mental imagery. The chaplain on the battlefield, ministering to the wounded, the firefighter rescuing the individual trapped in a building, the counselor talking to the student who has just lost a classmate, or the person who simply is there for a friend who is hurting are all those who provide crisis intervention at one level or another. But there is a point where a need arises for a higher level of training so that those who respond to those in crisis may do so with not only the intent to do no further harm, but the provisions and tools to accomplish the task.

This work will examine the differences between crisis counseling and psychotherapy, as well as the need to understand the differences between the two. Finally, the major factors in the victim-rescuer persecution triangle will be examined with a plan to limit becoming a part of this triangle. Scholarly articles will provide the information to be used in drawing the conclusions within this work.

Differences between Crisis Counseling and Psychotherapy

Perhaps the best way to introduce the difference between crisis counseling and psychotherapy is to determine what exactly it is that constitutes a crisis and compare the response of both disciplines. Hoff, Hallisey, and Hoff (2009) define crisis as ‘an acute emotional upset arising from situational, developmental, or sociocultural sources and resulting in a temporary inability to cope by means of one’s usual problem-solving devices’ (p.4). This is a broad definition as well as a clinical one. The breadth comes from being able to apply to varying situations across age, social, and cultural boundaries, and the clinical aspect results from being able to use this definition as a starting point for clinical work within a crisis situation. Another interesting definition of a crisis is ‘devices of change—that may be associated with extreme behavior’ (Boin, 2008, p. 211). This can also be said to be accurate as many times a crisis is a catalyst for change, whether it be personal, societal, or even global. This definition would seem to be unique to crisis counseling, as the brevity of crisis counseling limits the extended interaction between client and clinician that is necessary for successful psychotherapy. The major difference between psychotherapy and crisis counseling is that one is brief and focused, the other is more lengthy and has opportunity to explore the client’s situation more in depth.

One term that can be said to be of use in a crisis intervention situation is that of relationships. This term is common to both disciplines. Much of the effectiveness in psychotherapy is based upon the counselor/client relationship. Not the least important of these is the relationship between the person providing the intervention and the person in crisis. One of the most powerful relationships is that between the clinician and the client, and it is the clinician’s responsibility to manage this relationship in an ethical manner, as well as develop it as a clinical professional (ACA, 2000). There is also a burden upon the clinician in crisis intervention to make sure that their intentions and thoughts are communicated accurately and timely, in order to move the intervention process along. This is also one of the major differences between crisis intervention and psychotherapy (Hoff, et. al. 2009).

Another term that is critical to crisis intervention is the role of assessment. Assessment can play the part in crisis intervention of determining what treatments, if any, may need to be used beyond the role of brief therapy necessary for crisis intervention. Assessments can be accomplished by both formal and informal means, but any assessment should be conducted with the welfare of the client first and the completion of the assessment second. This will help to make the assessment tools and techniques used of maximum benefit, for ‘effective crisis intervention is dependent on accurate assessment that directly translates into focusing treatment when it is needed’ (Meyer and Conte, 2006, p. 959). Assessment is useful in psychotherapy as well, but is done over a longer period of time and sometimes on multiple occasions using multiple tools. In crisis counseling, the limitations of time often make extended assessments ineffective or cumbersome to use.

Planning and decision making are also key components in successful crisis intervention. When done according to a pre-arranged protocol in which the clinician has been properly trained, planning within a crisis can help to meet the immediate needs of the person in crisis such as food, shelter, clothing, and medical or psychiatric care. Indeed, in some instances patients who required psychiatric hospitalization had their length of stay decreased as a result of successful ambulatory care during a crisis intervention (Robin, Bronchard, and Kannis, 2007). It is important for the clinician to realize that good planning and decision making on behalf of the client can be beneficial later on. This can be accomplished by a good clinician-client relationship, and by using accurate assessment techniques and tools where required. This is done much more quickly in crisis counseling than in psychotherapy. In the therapeutic world, collaboration between the clinician and the client is often done over several sessions, where in a crisis counseling setting, this collaboration would be done over the space of a few minutes or a few hours at most.

Understanding and Applying these Differences

McAdams and Keener (2008) put forth a standardized approach to responding to crisis involving three basic tenets. They are preparation, action, and recovery. This work will explore the differences between psychotherapy and crisis counseling from within this framework. Preparation, from a clinician’s standpoint, involves learning as much as possible about various types of crises and how to best respond to them. This gives the clinician the upper hand in that there will be fewer opportunities for surprises as the crisis unfolds (McAdams and Keener, 2008). This also allows for exploration of resources the client already has and possible suggestion of new resources previously unknown to the client (Hoff, et., al, 2009). Preparation is valuable in psychotherapy as well, as the clinician is able to reference scholarly resources to help to determine potential avenues of treatment. This can help prevent the clinician from being consumed by the inherent dangers of working with people in crisis, whether they be in the counseling office or in a crisis in the field.

The action stage of crisis response could be said to put into practice that which will affect the most effective short term change for the benefit of the client. Meyer and Conte (2006) suggest a triage assessment system (TAS) that assumes behavioral, cognitive, and affective reactions to crisis events (p.960). In this manner, the best action to take on behalf of the client can potentially be judged or implemented based upon the reactions of the client to the crisis stimuli. Hoff, et. al (2009) seem to supplement this idea by involving the responses of facilitating of client decision making and reinforcing the client’s coping mechanisms (p. 120). This can help the client to move in a direction that will result in greater safety for the client and potentially increase the client’s well being later on. Flexibility is of paramount importance here as things may change suddenly within the crisis and the clinician must be able to adapt quickly and safely so as to protect the welfare of the client.

The action stage of psychotherapy includes implementing and revising the items collaborated upon by the clinician and the client in forming the client’s treatment plan. Again, this is where the clinician is often the motivator and encourager the crisis counselor is, as well as the educator that the crisis counselor does not have time to be. The clinician in psychotherapy finds new or improved coping mechanisms, the clinician in crisis counseling works with the existing coping mechanisms the client already has. This would be especially beneficial to a client who has a different set of values and beliefs than the clinician, as the clinician would seem to have less of an opportunity to proselytize or evangelize a client, even though both would be seen as a violation of professional ethics unless done with the express written consent of the client, which is unlikely in crisis intervention.

The recovery stage of a crisis can be said to be successful when ‘crisis survivors become able to manage the debilitating effects of the crisis sufficiently to resume precrisis levels of functioning’ (McAdams and Keener, 2008, p.393). In this case, both crisis counseling and psychotherapy share a similar goal. Again, the major difference between the two is the time involved to accomplish this goal. Both disciplines share a way to bring real hope and initiate real change in the client, but crisis intervention does so much more quickly than psychotherapy in most cases. Although there are many techniques common to both disciplines, such as active listening, reflection, establishing goals, and so forth, crisis interventionists must be prepared to initiate treatment much more quickly than psychotherapists in order to ensure client safety and change, often ‘within the first five minutes’ (Meyer and Conte, 2006, p.966). This also leaves no time for philosophical or value judgments to be made by either the clinician or the client, often removing the potential conflict that these things can bring.

The Victim-Rescuer Persecution Triangle

The relational triangle is ‘any relationship between two people that is dependent upon a third in order to maintain the status quo’ (Dunn, 2006, p.19). This can be applied to the victim-rescuer triangle in Hoff et. al.(2009) as the need to have a persecutor (or crisis) so that the rescuer (clinician) can come to the aid of a victim. In some instances, this identifies a need within the clinician to ‘need to be needed’ (Hoff et. al. 2009, p. 131) or seeing themselves as being the only person who can tend to someone in this state of crisis. Often times, this results in the clinician feeling satisfied while little real benefit is done to the client. Other ways this can be detrimental to a client are that the client’s right to their own grief and trauma is compromised, as well as inhibiting the client’s ability and sometimes even desire to heal. This can lead to increased resentment on the part of the client, and may lead to the client instigating a crisis in another person (persecutor) in order to deal with their own pain.

Some steps that can be taken to prevent enmeshment in this triangle are self-awareness by the clinician, and conducting accurate assessment of the client’s needs, and then providing only what is needed to manage the client through the crisis situation (Hoff et. al. 2009). Use and misuse of power should always be monitored by the clinician so that maximum benefit is done to the client with minimal harm. The clinician should always be self-aware and not try to rescue clients, because this is not the role the clinician should play in the healing process. This can also lead to potential ethical violations as the relationship may then exceed the boundaries of professional interaction. A good way to preserve the relationship and avoid enmeshment in a triangle such as this is for the clinician to remember that the relationship is above all a professional relationship, because the client is most likely not capapble or not willing to make this distinction.

Conclusion

This work has examined the differences and similarities between psychotherapy and crisis intervention from a clinical standpoint through use of scholarly articles and class text. Attention was also given to the victim-rescuer triangle and how clinicians can protect themselves from becoming enmeshed as they provide care to those in need. It is expected that those who serve in the helping professions must continually monitor themselves so as not to do harm to the client, and only practice within the boundaries and framework of their training. This will allow the clinician to operate with maximum effectiveness, whether they be on the battlefield or in the counseling office.

References

American Psychological Association. (2002). APA code of ethics.

Boin, A. (2002). Crisis Management, Vol. II. Los Angeles, Sage.

Dunn, T. (2006). Triangulation and the misuse of power: A dance of victims, villains, and rescuers. Human Development 27(1), 18-26.

Hoff, L.A., Hallisey, B.J., and Hoff, M. (2009). People in crisis: Clinical and diversity perspectives, 6^th ed. New York, Routledge.

McAdams III, C.R. & Keener, H.J. (2008). Preparation, action, recovery: A conceptual framework for counselor preparation and response in client crises. Journal of counseling and development. 86. 388-98.

Myer, R.A. & Conte, C. (2006). Assessment for crisis intervention. Journal of clinical psychology: In session. 62 (8), 959-970.

Robin, M., Bronchard, M., and Kannas, S. (2008). Ambulatory care provision versus first admission to psychiatric hospital: 5 year follow up. Social psychiatry. 43, 498-506.