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Crisis Intervention

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Running head: A Biblical Approach to Crisis Intervention

A Biblical Approach to Crisis Intervention and Brief Therapy

Brandon Carpenter

Liberty Theological Seminary Abstract The paper discusses the brief counseling approach to crisis intervention as utilized by the author. After a crisis is defined and determined, the author uses a short-term counseling methodology adapted from the ABC model as introduced in Kristi Kanal’s text. The counseling pedagogy blends the elements of the ABC model with biblical principles which may be used by the Christian counselor for the purpose of short-term crisis management.

A Biblical Approach to Crisis Intervention and Brief Counseling Every believer in Jesus Christ is called to a ministry of encouraging and helping others, especially to other brothers and sisters in the faith whose lives have been encroached upon by a crisis. Many times the abundant life that was promised by Jesus is disrupted when a crisis presents itself. Although every believer can experience the joy of their salvation through the ministry of the Holy Spirit which inwardly resides in them, Christians are not exempt from the distress and vulnerability that crises are capable of producing. Counseling, which is bathed in prayer and which appropriately uses and applies the Word of God, is an essential responsibility of Christian life and fellowship. Moreover, various intervention models and presuppositions are available for the Christian counselor to utilize and to adapt into a working biblical model to help others cope while experiencing a crisis situation. Therefore, it is imperative for every Christian counselor to adopt a theoretical approach to counseling which integrates sound biblical and theological principles in its methodology. Before a person can be helped through a crisis, a crisis must be identified and defined. Kristi Kanel states that a crisis must have three essential parts (Kanel, 2007). “The three parts of a crisis are these: (1) a precipitating event; (2) a perception of the event that causes subjective distress; and (3) the failure of a person experiencing the precipitating event to function at a lower level than before the event” (Kanel, 2007, 1). Indeed, Kanel’s three essential parts of a crisis have been identified in other, albeit separate, definitions. Albert Roberts defines a crisis as “a period of disequilibrium and decreased functioning as a result of an event or situation that creates a significant problem which cannot be resolved by using familiar coping strategies” (2000, 7). Another author states that a crisis is determined not by the event itself but by the individuals perception of and response to the situation (Parad, 1971). Thus, Kanel’s trilogy definition seems most appropriate in determining if a person is experiencing a crisis or not. She further explains that after the three components are identified, the most important element on which to focus is the individual’s perception of the event which caused the distress (2007). She states, “If the goal of a crisis worker is to increase functioning . . . the method involves changing the perception of the precipitating event. The best one can do is work at changing or altering the client’s cognition and perception of the event, offer referrals to supportive agencies, and suggest other coping strategies” (Kanel, 2007, p. 2). Paradoxically, every crisis has the potential of either danger or opportunity. H. Norman Wright states, “Being alive means that we constantly have to resolve problems. Every new situation we encounter provides us the opportunity to develop new ways of using our resources in order to gain control” (2003, 9). Thus, the counselor has a great task at helping to redirect the individual’s perception of the precipitating event so that coping skills may be increased and personal growth may occur (Kanel, 2007). Once a determination that a person is truly experiencing a crisis is made, then the process of crisis intervention begins. Depending upon the author or practitioner, various steps or phases are involved in crisis counseling. Albert Roberts suggests three steps in his ACT Intervention Model for Acute Crisis and Trauma Treatment (2002). Greenstone provides a six-step procedure for crisis intervention: immediacy, control, assessment, disposition, referral, and follow-up (2002). However, the ABC model of crisis intervention as introduced in Kanel’s text seems to incorporate the necessary elements of crisis intervention into three steps. The adopted model of crisis counseling adopted by the author of this paper comes from an amalgamation of the ABC model and biblical precepts used by Christian counselors. The initial phase of helping an individual as described by Kanel is the development of rapport with the individual. This is the stage where understanding and trust is developed between the client and the counselor (2007). Regarding this initial phase Howard Stone states, “This involves physically attending to the other person by listening carefully, temporarily suspending judgment, and offering appropriate warmth and respect” (1994, p. 21). The building of trust and understanding is also a biblical principle which was modeled by Jesus Christ during his earthly ministry. Indeed the very characteristics that He displayed as He counseled people who were hurting are necessary in establishing rapport with clients. Since He was compassionate for others, He was motivated to alleviate sufferings and meet their needs. In addition, Jesus accepted people for who they were and elevated their self-worth by making them His main concern. Moreover, Jesus modified His choice of words and inflection of voice based on the crisis at hand and to whom He was speaking (Wright, 2003). Practically, this initial phase of building trust, understanding, and a proper relationship with a counselee involves all that Jesus modeled as a counselor. The counselor must be compassionate and show compassion. This is accomplished through telling the counselee that he/she is cared for (Phil.1:8), praying with them and for them (Col. 4:12-13), rejoicing and grieving with them (Rom. 12:15), dealing gently and tenderly with them (Matt. 12:20), and defending them against those who mistreat and accuse them (Matt. 12:1-7). Moreover, the Bible is clear that respect must be given to all people. The counselee must know that they are respected. Therefore, it is imperative that the counselor show respect through proper verbal and nonverbal communication. The counselor must also legitimize the client and take their problem seriously. Finally, the counselor must maintain confidentiality of the one who is in crisis (Mack, 1994). Kanel explains that asking open-ended questions not only provides the counselor with insight into the thoughts and feelings of the client, but it allows the client to become more comfortable with the counselor. In addition to questioning, rapport with the client can be established through empathizing with the clients and summarizing what the client has stated throughout the initial meeting (Kanel, 2007). After the initial phase of establishing rapport, Kanel describes the next phase of crisis intervention as identifying the problem (2007). Identifying the problem not only requires a focus on the precipitating event, but includes collecting data in at least six areas: physical, resources, emotions, actions, concepts, and historical (Mack, 1994). Stone adds, “One of the first tasks in brief pastoral counseling is to identify the central problem(s). The general issues need to be defined clearly and in specific, concrete terms” (1994). Since physical problems can be a result of spiritual problems, then an assessment of the physical health of the individual is important. Mack states, “In 2 Corinthians 4:16, Paul implies that when ‘our outer man is decaying,’ our inner man tends to lose heart” (1994). Information about sleep patterns, diet, exercise, previous and current illnesses, and medications can assist the counselor in understanding and solving the inward problems that may have resulted from a crisis. Also, an evaluation of the resources available to the individual can aid the counselor to help him/her develop coping skills (Mack, 1994). Since the greater access the person has to material, personal, and social resources is correlated to higher functionality, all available resources should be researched (Kanel, 2007). In addition to an evaluation of the physical health and the resources of the individual, the counselor should observe the client’s emotions. Emotions are the external warning signs of an internal problem. Likewise, a person’s actions are indicative of a problem within (Mack, 1994). In describing the relationship between actions to other aspects of the lives of individuals Mack states (1994): The Bible makes a close connection between our actions and other aspects of our lives. Actions have a profound effect on our spiritual, emotional, and physical health. Again consider Cain, who was not only angry but also depressed. . . . Cain sinned by bringing an inappropriate sacrifice to the Lord, and the rest of the chapter indicates a direct correlation between that action and every part of his life. One disobedient action affected his relationship to God, produced various negative emotions, and led to further sinful actions against his brother (pg. 217).
The counselor must also gather data about the person’s concepts including what the individual thinks or desires. Since thoughts and desires influence actions, spark emotions, and provide motivation; it is important to evaluate the concepts of the individual in crisis. Moreover, the conceptual area includes the people whom the person in crisis trusts, listens to, depends upon, and fears. Finally, historical data of the person should be collected. Having information about past experiences, failures, temptations, successes, and pressures of life will aid the process of developing coping skills (Mack, 1994). Three primary methods of gathering this data are: using personal data inventory, asking questions (much of this information could be gathered during the first phase), and observing the client during the session (Stone, 1994). Since the goal of crisis intervention is to change the client’s perception of a precipitating event which resulted in a crisis, it is imperative that the precipitating event be identified. George Everly states, “[T]he direct implementation of crisis intervention tactics is predicated upon evidence of human distress and/or dysfunction, not merely the occurrence of an event (critical incident)” (Everly, 2000, 2). Although in the previous statement, Everly differentiates a crisis from the precipitating event; his point that the distress is a result of the occurrence of the critical event is well taken. Therefore, even though some precipitating events may be difficult to identify, through questioning and observation, the counselor can help the client identify the critical event by determining when the client began to feel badly or distressed (Kanel, 2007). Once the critical event is identified, the counselor should explore the significance of the crisis situation from the client’s perceptive. In addition, the emotional and affective responses of the individual in crisis must be evaluated (Roberts, 2002). Included in this step is the evaluation of how the crisis is affecting the client’s functioning. Kanel states, “Clients seem to benefit from expressing painful feelings and sharing other symptoms—symptoms that may impair clients’ occupational, academic, behavioral, social, interpersonal, or family functioning. Counselor’s should ask how the client’s perceptions about the precipitating event are affecting their functioning” (2007, 83). Identification and assessment of the problem is a task in which both the counselor and the counselee participate (Stone, 1994). In addition to identifying the problem, the counselor must identify any ethical issues or substance abuse issues that may exist. The use of the American Academy of Crisis Interveners Lethality Scale would be useful for identifying the client’s risk of suicidal ideations (Greenstone, 2007). In addition to being a danger to himself, a determination of the risk of harming others should be made. If sexual abuse or child abuse is discovered, it must be reported immediately. In addition, if it is determined that the client is at a medium to high risk of harming him/herself or others, then a possible referral to an agency or community resource should be made to ensure the safety of everyone involved. Also, any client who is determined to be under the influence of a substance is at a greater risk of harming himself and others. Thus, a referral to another agency that specializes in dealing with substance abuse should be contacted and utilized (Stone, 1994). Once it is determined that the client poses no threat to others, is not under the influence of a chemical substance, or is not suffering from a disorder caused by a chemical imbalance; then the counselor may proceed with the process of helping the client cope with the problem at hand. This process includes a valuable component in the helping the client through the process of increasing coping skills and functioning: listening. Wright states, “Listen and listen some more—with your heart and your eyes, not just with your head and your ears. Your listening will let you know the person’s level of functioning and coping” (1994, 168). Listening to the client includes listening to how they said it as well as what they said (Mack, 1994). Throughout the process of listening the counselor must normalize what has been said. Normalizing allows the client know that what he/she is experiencing—the physical, emotional, spiritual struggles—are normal, and they experienced by many people who are at this same phase. This validation gives hope and encouragement to the counselee (Wright, 2003). Moreover, the client who seeks out counseling perceive that his/her problem is an ongoing dilemma with subsists all the time. The counselor should help the client find exceptions to this perception (Stone, 1994). Steve de Shazer states (1991):
Problems are seen to maintain themselves simply because they maintain themselves and because clients depict the problem as always happening. Therefore, times when the complaint is absent are dismissed as trivial by the client or even remain completely unseen, hidden from the client’s view. . . . For the client, the problem is seen as primary and the exception, if seen at all, are seen as secondary (pg. 58).
Thus, the exception can become the goal of the intervention process. As the counselor works with the hurting individual, reassurances that they will work through the problems together, that all available resources to assist the person will be used if necessary, and that the counselor will support any effort made by the client should be abundantly clear (Wright, 2003). Educating the client through printed material, statistics, or case studies will aid the counselee in coping with the problem. Kanel states, “Educating statements may include psychological, social, and interpersonal dynamics, or they may provide statistics or frequency of the problem. In any case, when a counselor helps people in a crisis state increase their knowledge of facts, the clients will have stronger coping skills for the current crisis and future crises” (2007, 86). Once the problem is identified and assessed, the sole purpose of crisis intervention is to help the client manage the problem (Greenstone, 2002). A vital management technique is to actualize the crisis; that is, break it down into manageable, smaller pieces which can be individually addressed (Ragg, 2001). Since crisis intervention is brief in nature, its goal is to identify the resources, strengths, and previous coping skills of the individual to raise his/her functioning level. Although identifying the problem is vital in crisis intervention counseling, the counselor is less interested in why the problem arose and is more concerned about working with the counselee to find a manageable arrangement to relieve or lower the stress level which resulted from the problem. As the anxiety level of the person drops, he/she will see their circumstances in a more objective and rational manner. When the stress level is reduced, then the counselee can better reflect on what has happened and on what is now taking place. Therefore, once the problem is identified and actualized and once the client has been validated, reassured, educated, and supported; then the counselor shifts all attention to the possible solutions and management of the problem(s) (Fernando, 2007). At this point, the counselor and patient utilize all available resources and call upon previously developed coping skills to brainstorm and suggest solutions to the problems. After all optional solutions have been investigated, then a plan based upon workable solutions, which is realistic and attainable with prioritized needs is developed (Wright, 2003). For a believer in Christ, the ultimate solutions emerge from a growth in godliness. All plans which are developed cooperatively by Christian counselors and their clients with the objective of greater management of a problem and functioning should always keep this goal in mind—Christian maturity (Crabb, 1987). Therefore, a plan developed to help the client to better cope with the problem must implement a God-centered approach. Mack states, “True change takes place when people make choices primarily for the purpose of bringing glory to God rather than seeking to meet their own needs” (1994, 272). Once the plan is developed, the counselor must be assured that the client understands the necessary steps in order to accomplish the objective. Douglas Bookman adds, “[B]iblical counselors must constantly and consciously arm their spirits, inform their instruction, and constrain their counselees with a commitment to glorify God and God alone” (1994, 160). Moreover, the steps must be attainable in a short amount of time (Stone, 1994). The next step is taking action and working the plan. After the objective is identified, the resources to be utilized in order to meet the objective are selected, and the plan to increase coping skills is developed; immediate action is necessary. Wrights states, “People in crisis tend to flounder, and we need to move them toward meaningful, purposeful and goal-oriented behavior. They need to know that something is being done by them and for them” (2003, 169). O. Hoabart Mowrer suggests giving homework-type of tasks which will move the client toward better coping skills (in Clinebell, 1977). An effective approach to alter behavior and bring about change is to address the precise problems and take steps toward resolving those problems in real life through the use of task–oriented homework which take place outside of the counseling sessions. Homework ideas will normally arise during the dialogue between the helper and the counselee. Normally, the counselor will interpret the abstract concepts of the objective into concrete, manageable tasks that client can perform between sessions during his/her life routine (Stone, 1994). Larry Crabb offers a practical example of a homework-type assignment (1977):
A woman had developed the habitual response of lashing out at people who criticized her. We determined together that her wrong assumption involved the belief that her security depended on always being appreciated for her efforts. Because her temperament was naturally aggressive, she learned to express through anger the insecurity and hurt occasioned by criticism. We agreed in counseling that the next time she was criticized, she would immediately start playing the tape, “Jesus loves me so I am secure whether I am criticized or not.” On the strength of a commitment to act consistently with the sentence, she agreed not to lash back but to respond gently and warmly to her critic. . . . She later reported that as she followed the directions, she felt mechanical and unreal, as if she were playing a game. But afterward, she began to feel a little better about herself (p. 158).
While the homework assignments may seem “mechanical” as the woman in Crabb’s illustration stated, they are necessary to put into practice the objectives of the plan. Moreover, they are practical exercises carried out by the client which builds coping skills for future crises that may arise (Crabb, 1977). In addition to practical assignments, the counselor must build up the client’s defenses by encouraging him/her to use all available resources, strengths, support systems, and previous coping skills to accomplish the plan. Throughout the entire process, helping the client to evaluate his/her progress, offering solutions to any failed strategies in the plan, and encouraging the client’s success is the continued obligation of the counselor (Wright, 2003). Stone states, “The best way to build upon the person’s strengths is to show them hospitality. The counseling session needs to be a place where counselors are welcomed, encouraged, and complimented for what they are doing well, not where their past wrongs or present pathology is dredged up” (1994, 30). Additionally, the client should be encouraged to evaluate his/her strengths, resources, and capabilities as well as any growth which as occurred throughout the process. Moreover, the counselor should be available for continued support for his/her client. The use of the telephone or e-mail is invaluable in supporting a client. Contacting clients between sessions and letting them know that prayerful intercession is being made on their behalf would be a tremendous encouragement to those who are actively trying to increase coping skills. In addition, expanding the client’s support system would promote and equip the counselee to meet the established goals (Wright, 2003). Kanel suggests, “For example, a client might have said that one of the things that made her feel better was talking to her girlfriends about her divorce. But now, she says, they are tired of listening. This should trigger in the counselor the idea that this client feels better talking to a group of women about her problem. Getting the client to accept a referral to a support group should not be difficult . . .” (2007, 89). Once the client has experienced success and has acquired the basic skills necessary to cope with the current crisis, the brief counselor should seek to end the counselor-counselee relationship. Although other internal problems may exist and need to be addressed, the short-term support of the crisis-intervener must come to an end. It may be necessary to make additional referrals to other counselors or therapists for long-term care. Moreover, the counselor should make it clear that the person is welcome to return when new or recurring crisis-type issues emerge (Stone, 1994). While the brief counselor has many alternatives and methodologies from which to choose, the ABC model of crisis intervention interwoven into a biblical worldview is the chosen method utilized by the author. The ABC method involves three steps and is put into motion after a crisis is identified. The first step involves building rapport and trust with the client through questioning, listening, and using the counseling approach as modeled by Jesus Christ. The second step includes identifying the problem and helping the client to relieve the anxiety associated with the problem through education, empowerment, validation, and encouragement. Moreover, solutions and objectives are established in step two. Step three also involves searching for solutions and strategies that lead to growth in godliness and the glorification of God. Step three is working the plan—it is putting into practice what was discussed in step two. Step three involves task-oriented assignments given to the client as well as the continued support of the counselor throughout the process of coping with the problem.

References
Bookman, D. (1994). The Godward focus of biblical counseling. In MacArthur, J. & Mack, W. (Ed.), Introduction to Biblical Counseling, Dallas: Word.

Clinebell, H. (1984). Basic Types of Patoral Care and Counseling (2nd ed.). Nashville: Abingdon Press. (Original work published 1977)

Crabb, L. (1977). Effective Biblical Counseling. Grand Rapids: Zondervan Publishing House.

Crabb, L. (1987). Understanding People. Grand Rapids: Zondervan. de Shazer, S. (1991). Putting Difference to Work. New York: W.W. Norton.
Everly, G. (2000). Five Principles of Crisis Intervention:Reducing the Risk of Premature Crisis Intervention. International Journal of Emergency Mental Health, 2(1), 1-4.

Fernando, D. (July 2007). Existential Theory and Solution-focussed Strategies: Integration and Application. Journal of Mental Health Counseling, 29(3), 226-232.

Greenstone, J., & Leviton, S. (2002). Elements of Crisis Intervention: Crises and How to Respond to Them (2nd ed.). Pacific Grove: Brooks/Cole.

Kanel, K. (2007). A Guide to Crisis Intervention (3rd ed.). Belmont: Thomson.

Mack, W. (1994). Biblical counseling and inducement. In MacArthur, J. & Mack, W. (Eds.), Introduction to Biblical Counseling (pp. 268-283). Dallas: Word.

Mack, W. (1994). Developing a helping relationship with counselees. In MacArthur, J & Mack, W (Eds.), Introduction to Biblical Counseling (pp. 173-188). Dallas: Word Publishing.

Mack, W. (1994). Taking counselee inventory: collecting data. In MacArthur, J. & Mack, W. (Eds.), Introduction to Biblical Counseling, Dallas: Word Publishing.

Parad, H. (1971). Crisis Intervention. In R. Morris (Ed.), Encyclopedia of Social Work (16th ed ed., pp. 196-202). New York: National Association of Social Workers.

Ragg, M. (2001). The Foundation of Generalist Practice. Boston: Allyn and Bacon.
Roberts, A. (2000). An overview of crisis theory. In A. Roberts (Ed.), Crisis Intervention Handbook: Assessment, Treatment, Research, New York: Oxford University Press.

Roberts, A. (2002). Assessment, Crisis Intervention, and Trauma Treatment: The Integrative ACT Intervention Model. Brief Treatment and Crisis Intervention, 7(2), 1-21.

Stone, H. (1994). Brief Pastoral Counseling. Minneapolis: Fortress Press.
Wright, N. (2003). The New Guide to Crisis and Trauma Counseling. Ventura: Regal Book.

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