UNIT V: CRISIS, TRAUMA AND EMERGENCY COUNSELLING

1. CRISIS INTERVENTION MODELS

1.1 What is a Crisis?

A crisis is a state of intense psychological imbalance that occurs when a person faces a stressful event and feels unable to cope with it using their usual coping strategies.

It is important to understand that:

• A crisis is not defined by the event itself.
• It is defined by the person’s perception that the event is overwhelming.

For example:

• Two individuals may lose a job.
• One adapts quickly.
• The other experiences panic, hopelessness, and suicidal thoughts.

The second individual is in crisis.

1.2 How Does a Crisis Affect a Person?

During a crisis, a person may experience:

Emotional Effects

• Panic
• Fear
• Anger
• Helplessness
• Hopelessness

Cognitive Effects

• Confusion
• Poor decision-making
• Negative thinking
• Catastrophic thinking

Behavioural Effects

• Withdrawal
• Aggression
• Impulsivity
• Self-harm behaviour

If not addressed, crisis may develop into mental disorders.

1.3 DSM-5-TR Perspective on Crisis

The DSM-5-TR does not classify “crisis” as a diagnosis. However, unresolved crisis can lead to diagnosable disorders such as:

• Acute Stress Disorder
• Posttraumatic Stress Disorder (PTSD)
• Major Depressive Disorder
• Adjustment Disorder
• Substance Use Disorder
• Suicidal Behaviour

Therefore, crisis intervention acts as a preventive mental health strategy to stop progression into full psychiatric conditions.

1.4 Types of Crisis

1. Developmental Crisis

Occurs during normal life transitions. Example: adolescence, marriage, retirement.

2. Situational Crisis

Caused by sudden unexpected events. Example: accident, job loss, sudden death.

3. Traumatic Crisis

Caused by life-threatening events. Example: violence, assault, disaster.

4. Existential Crisis

Related to identity, meaning, or life purpose.

Each type requires specific assessment and intervention.

1.5 Major Crisis Intervention Models

(A) Caplan’s Crisis Theory

Gerald Caplan explained that crisis happens when usual coping strategies fail.

His model focuses on:

• Identifying the stressor
• Allowing emotional expression
• Strengthening coping skills
• Activating social support

The goal is to restore balance quickly.

(B) Roberts’ Seven-Stage Crisis Model

This is a structured, practical model used in hospitals and emergency settings.

It includes:

1. Assessing risk (especially suicide risk)
2. Establishing rapport
3. Identifying the main problem
4. Encouraging emotional expression
5. Exploring alternatives
6. Developing an action plan
7. Follow-up

This model is especially useful in suicide prevention.

(C) Psychological First Aid (PFA)

WHO strongly recommends Psychological First Aid in disaster and emergency situations.

PFA includes:

• Ensuring safety
• Helping the person feel calm
• Connecting them to support
• Encouraging hope
• Providing practical help

WHO clearly states that forcing people to talk about trauma immediately after an event may be harmful.

1.6 WHO Recommendations for Crisis Management

The World Health Organization recommends:

• Community-based crisis services
• Suicide prevention programs
• Training non-specialists through the mhGAP programme
• School-based life skills education
• Restricting access to suicide means

WHO promotes early intervention and prevention over hospitalization whenever possible.

1.7 Suicide Risk Assessment

During crisis intervention, suicide assessment is critical.

According to DSM-5-TR, suicide risk increases in:

• Major Depressive Disorder
• Bipolar Disorder
• PTSD
• Substance Use Disorders
• Borderline Personality Disorder

Counsellors must assess:

• Suicidal thoughts
• Specific plan
• Access to means
• Previous attempts
• Protective factors

WHO emphasizes safety planning rather than only giving advice.

1.8 Goals of Crisis Intervention

• Ensure safety
• Reduce emotional intensity
• Restore rational thinking
• Strengthen coping ability
• Prevent mental disorders
• Connect to long-term support

1.9 Ethical Issues in Crisis Work

Confidentiality vs Safety

If the person is at risk of harming themselves or others, confidentiality may be broken ethically.

Informed Consent

Crisis may impair decision-making ability.

Cultural Sensitivity

Crisis expression differs across cultures.

Documentation

Accurate record-keeping is essential in high-risk cases.

2. TRAUMA-INFORMED COUNSELLING

2.1 What is Trauma?

According to DSM-5-TR, trauma involves exposure to:

• Actual or threatened death
• Serious injury
• Sexual violence

This exposure may be:

• Direct
• Witnessed
• Indirect (learning about close family trauma)
• Repeated exposure (e.g., emergency workers)

2.2 Trauma-Related Disorders (DSM-5-TR)

• Acute Stress Disorder
• PTSD
• Reactive Attachment Disorder
• Dissociative Disorders

Symptoms include:

• Flashbacks
• Nightmares
• Hypervigilance
• Avoidance
• Emotional numbness

2.3 Principles of Trauma-Informed Counselling

WHO and global trauma guidelines emphasize:

1. Safety
2. Trust
3. Choice
4. Empowerment
5. Cultural sensitivity

The counsellor must avoid re-traumatization.

2.4 Phases of Trauma Treatment

Phase 1: Stabilization

• Grounding techniques
• Breathing exercises
• Emotional regulation

Phase 2: Processing Trauma

• Trauma-focused CBT
• EMDR
• Narrative therapy

Phase 3: Reintegration

• Restoring relationships
• Building resilience
• Re-engaging with life goals

WHO recommends scalable interventions like Problem Management Plus (PM+) in low-resource settings.

3. DISASTER, VIOLENCE AND SUICIDE-RELATED INTERVENTIONS

3.1 Disaster Counselling

Disasters (earthquakes, floods, pandemics) cause:

• Acute stress
• Survivor guilt
• Grief
• Anxiety

WHO recommends:

• Psychological First Aid
• Community support systems
• Referral for severe cases

Mass emotional debriefing is not recommended routinely.

3.2 Violence-Related Interventions

Violence survivors may develop PTSD, depression, or suicidal ideation.

Intervention includes:

• Safety planning
• Legal referral
• Trauma-focused therapy
• Empowerment counselling

WHO emphasizes survivor-centered, confidential approaches.

3.3 Suicide-Related Interventions

Suicide is a major public health concern.

WHO’s LIVE LIFE strategy focuses on:

• Restricting access to means
• Responsible media reporting
• Life skills education
• Early identification and support

Counselling involves:

• Risk assessment
• Safety planning
• Family involvement
• Emergency referral if required

4. ETHICAL AND SAFETY CONSIDERATIONS

Crisis and trauma counselling require strong ethical awareness.

Key considerations:

• Duty to protect
• Confidentiality limits
• Cultural respect
• Professional competence
• Counsellor self-care

WHO recognizes the importance of protecting mental health workers from burnout and vicarious trauma.

Conclusion

Crisis, trauma, and emergency counselling form the backbone of acute mental health response systems. DSM-5-TR provides structured diagnostic clarity, while WHO offers global public health guidance for scalable interventions.

Together, they ensure that crisis counselling is:

• Evidence-based
• Culturally sensitive
• Ethically grounded
• Preventive
• Life-preserving

This field is not only about therapy — it is about stabilizing human life during its most vulnerable moments.