This category is a little bit of a catch all, not only will it cover crisis intervention strategies, but also community intervention, and group therapy. Considering the high weight of this particular topic you can most likely expect a few questions on crisis intervention strategies or the other topics covered in this post. Treatment, Intervention, Prevention, and Supervision covers 14% of the exam, and this study guides mentions a few of them. The information is best used in collaboration with your own knowledge and what you have already been taught, your previous notes or textbooks, and research if you need more information on a particular topic. Or you could check out the product reviews page.
A crisis on a personal level is any situation a person experiences in which they feel they have exhausted their coping strategies. Crisis can also occur on a societal level, but for the purpose of this discussion we will focus on individual crisis. Crisis intervention focuses on restoring equilibrium and balance as quickly as possible in order to minimize potential development of chronic symptoms. Treatment involves rapidly establishing rapport, reviewing what led to the crisis, helping the individual understand their unhelpful reaction, supporting the individual to learn new more helpful ways to cope, and how to avoid potential foreseeable future crisis. As soon as the crisis is over the therapy is terminated.
Caplan’s 4 Phases of Crisis:
Developed in 1961, and defined a state of anxiety and emotional unrest due to the individual facing a problem they
can not solve. It can result in an inability to function for a long time, and he identified 4 stages of reaction:
- Initially tension and disorganization rise, often the individual unsuccessfully tries to manage the situation with previously learned coping strategies.
- This tension starts to disrupt daily living.
- Depression increases, individuals may give up on goals or seek help from others.
- If the crisis persists the end result is psychological breakdown.
Roberts 7 Stage Crisis Intervention Model
Developed in response to the September 11, 2001 attack in the United States, he created the ACT model, which stands for Assessment Crisis Intervention Trauma Treatment. Contact is meant to be minimal, yet goal directed and effective in order to make the most out of limited time.
- Intake and Assessment of the individual after the crisis. This is an assessment of imminent danger, rapport needs to be established very quickly in order for the individual to share information.
- Explore the Crisis Situation. Identify the main problem(s) and what in their personal life has potentially led to these events. The client is given the control to use their own words to tell their story.
- Understand the individuals Coping Style. Ask the individual to describe the situation and try to understand what they trying to do to cope (which is most likely not effective).
- Confront Feelings, Explore Emotions, and Challenge Coping. This is the time when the therapist starts to guide the individual to explore and label emotions, validation is very important at this part. And carefully starting to challenge the individuals maladaptive responses.
- Discuss Solutions and Educate on Helpful Coping. This is a process done in collaboration with the individual and the therapist. Utilizing what the individual has used in the past as well as how to build on these skills.
- Develop a Treatment Plan and Reassurance. This treatment plan should be empowering, concrete, and something the individual can realistically implement. If the client is capable of finding a meaning in the situation it can help them to overcome it.
- Follow-up. This is used as an evaluation and a potential booster session to navigate potential speed-bumps and problem solve.
There are additional crisis models such as the SAFER-R Model and Lerner and Shelton’s “10 steps to acute stress & trauma management.”
Community psychology was a result of the Community Mental Health Act in 1963 in the United States, and focuses on the use of established community organizations. The goals include early intervention and moving treatment away from hospitals to outpatient settings (which includes schools). The focus is primarily on prevention, treatment and rehabilitation and is closely related to social psychology, ecological psychology and environmental psychology. Prevention alone has 3 sub-categories: a) Primary, preventing the occurrence by implementing intervention such as education or building resiliency in children b) Secondary, focuses on early identification and treatment before it becomes more severe c) Tertiary, reducing relapse and additional negative consequences of a disorder. Watzlack identified 2 forms of change: First order change focuses on changing the individual in order to fix the identified problem, where as second order change focuses on changing the system or environment to fit the individual.
4 Types of Mental Health Consultation
Not all intervention occurs in direct contact with the client, and consultation is a way in which the individual can be served indirectly. Caplan identified 4 categories based on: a) whether or not the concern is regarding the client or administration and b) whether the goal is to provide information or to increase staff capacity.
- Client-Centered Case Consultation: A common form of consultation. The consultee (person working directly with the client) approaches an expert consultant (such as a supervisor) with a case study on an individual client in order to best support the client or develop a treatment plan.
- Consultee-Centered Case Consultation: The focus of this model is primarily on the consultee, and the client’s treatment plan is of secondary concern. For example is a therapist is feeling triggered or some counter transference with a particular client, the therapist may become the consultee and approach a supervisor (consultant) for support in managing their own reactions and distress about working with a particular client.
- Consultee-Centered Administrative Consultation: This focuses on system and administrative concerns rather than a specific client. In this model the consultant’s role is to increase the consultee’s ability and effectiveness in a specific program, such as providing education or addressing some of the consultee’s limitations.
- Program-Centered Administrative Consultation: In this model the consultant is addressing the issues of a program as a whole, and may be making recommendations on how to change or develop entire systems.
Group therapy can refer to any collection of individual receiving therapeutic intervention from one person, and could be CBT or psycho-educational. Typically group therapy refers to a psychodynamic approach which highlights and values the group process. Founded by Pratt, Buroow and Schilder, there have been many developments by individuals such as Moremo, Slavson, Sponitz, Yalom and Ormont to name a few. Irvin Yalom is an existential pyschiatrist and was one of the most influential contributors to the discipline in the late 60s and 70’s. He identified 12 therapeutic factors that result from being a part of a group:
- Universality: Recognition of shared experience.
- Altruism: Members help each other, the giving process helps develop self-esteem.
- Instillation of Hope: Seeing individuals further along in their journey can instill hope.
- Imparting Information: Information from a peer also navigating the system and resources is reported to be very helpful.
- Corrective Recpitulation of the Primary Family Experience: The therapist encourages and helps to bring consciousness to transference.
- Development of Socializing Techniques: Member take risks to devlop their social skills.
- Imitative Behavior: Modelling the therapist and other group members can help improve social skills.
- Cohesiveness: All individuals in the group feel a sense of validation and belonging.
- Existential Factors: Taking responsibility for your own actions and dealing with the consequences.
- Catharsis: The feeling of relief from distressing emotions by being able to tell their story in a supportive environment.
- Interpersonal Learning: The group feedback helps to improve self-awareness.
- Self-Understanding: Development of insight and and bringing awareness to the unconscious.
Yalom also identified 3 stages of group cohesiveness which progress through orientation, conflict, and finally cohesiveness. The group can be made up of people experiencing a variety of different forms of conflict or presenting problem, but should ideally have individuals with similar levels of ego strength.
You may find the information on this site is not enough to help you feel confident about your ability to pass the exam, That is OK and only you can be the judge of what you need. If this information seems overwhelming to you it does NOT mean you will fail the exam, but you may require a little more in depth material than is offered here That is why there is a Product Reviews page which will give you a variety of additional options, as well as practice exam questions which I highly recommend as explained on the Study Tips page.
***There are so many different forms of therapy it is difficult to list them all, and if you try to know them ALL before you write the EPPP you will never actually get around to writing it. It would be great if you would share some of the interventions or treatments models that you find important that maybe have not been covered. Or maybe you have come across a practice exam question that asked about a specific model, or if you have any questions I would be happy to get back to you, just leave a comment below.