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POTENTIAL CUMULATIVE EFFECTS

Once we have a clear crisis focus and a satisfactory definition of the crisis, our assessment turns to the individual and his situation.  Remember, we are not seeking full understanding in the psychiatric sense.  In crisis intervention, we concentrate on looking for immediate and potentially long-range cumulative effects.  The notion here is that crises tend to spread out or diffuse.  It is rather like the well-known “snowball” effect.  As a generalization, “crisis tends to be contagious.”  In any crisis, anticipated diffusion is included as a special part of the crisis definition.  Consider this very exaggerated example.  Suppose Dick’s crisis involves a severe marital disruption.  The precipitating event was a serious argument in which he learned of his wife’s marital infidelity.  We find him very hurt, frustrated, angry, and feeling that the only solution is for him to pack his bags and leave.  Let’s think about what the “snowball” effect (the potential cumulative effects) of his leaving might be.  If Dick leaves his wife, his boss might fire him.  If he loses his job, his wife may not have enough income to care for the children.  As a result of her frustration and discouragement, she may neglect them.  If she finds herself unable to care for the children, she may leave them with her mother, whom Dick and the children detest.  If the children are forced to stay with their grandmother, the oldest one (age sixteen) may run away.  If she runs away, she may get hurt or in trouble with the police.  If the police get involved, Dick’s friends and business associates may find out about it.  If they find out about it, his social position and interpersonal relationships may be jeopardized.  If that happens, he may become even more angry, hurt, frustrated, and at a loss as to what to do.

This example is, of course, quite exaggerated.  Nevertheless, we need to see that people in crisis tend to act in impulsive and sometimes self-destructive ways.  One of the main reasons for this is that they tend to be functioning less as rational, reasoning people and more as feeling, emotional, impulsive individuals.  Most crisis situations result because feeling and emotion have supplanted reasoning and planning.  Thus, it is difficult for people in crisis to think ahead, anticipate the consequences of their behavior and actions, or develop plans leading to a satisfactory solution for their problems.  This is, in large measure, what we mean when we judge a crisis to have a low self-resolution factor.  As we intervene into crises, then, along with asking, “What happened?” we want to ask the individual, “What ideas do you have for dealing with the problem?” and “What do you think will happen if you follow through with those ideas?”  In that way, we can help him consider possible implications of his ideas and impulses and begin to help him think about alternative solutions and alternative ways of dealing with the crisis.

Considering such possible cumulative effects, focusing on the nature and implications of crisis behavior, and influencing alternative behavior and planning, gives us further insight into the nature of crisis intervention.  We are beginning to deal with the most common question asked by newcomers to crisis intervention methodology; namely, “What do I say?”  We also can see that in crisis intervention we are developing a relationship in which our primary role is to understand what is happening, to ask questions, and to serve as a sounding board for the feelings and ideas of the person in crisis.

As we think about potential cumulative effects, we are really thinking beyond the now potential, which is, of course, the worst possible outcome of the crisis.  In addition to the worst possible outcome, a crisis may have other outcomes and implications.  People in crisis are generally not in an emotional position to be able to think through these possible outcomes and implications.  They have difficulty fully understanding and thinking about the cumulative effects of their situation.  Nevertheless, they feel compelled or impelled to do something about the problem.  The tendency is to do something very drastic.  In some crisis situations, the individual may consider the possibility of killing himself.  In one situation already discussed, a teenager (Ann) had decided to go to a friend’s house and get turned on with drugs.  In another situation, a mother (Mrs. F) had decided to take her son to juvenile court.  It is important to see that people in crisis are extremely uncomfortable and feel a strong need to reduce this discomfort, or pain.  In psychological terms, most people tend to have a low tolerance for situational ambiguity or confusion.  They have a need to reduce the ambiguity or confusion, on the one hand, or if it is not possible to reduce it, they have a strong need to avoid it, on the other hand.  Emotionally, they are pressed either toward doing something about the problem or, in some way, running away from it.  This fact of human nature is what accounts for the cumulative effects discussed earlier.  The individual is upset and probably agitated.  His efforts to do something about the problem result in making things worse.  Similarly, if he chooses to avoid or run away from the problem, that too can make things worse, but at least he feels that he is doing something.  Very rarely do people in crisis consider the possibility of doing nothing.

Do nothing?  That seems too easy.  In most crisis or tension situations, doing nothing is, in fact, extremely difficult.  Yet, in crisis intervention, the wisest course may be to encourage the individual to tolerate the discomfort, the pain, the confusion, and the ambiguity.  The suggestion is therefore, when in doubt, do nothing.  As we talk with those in crisis about their possible courses of action, we should ask them, “What would happen if you simply did nothing?”  This question surprises people.  It has not occurred to them that one of their options is to do nothing.  They can wait to see what happens.  As you think with them about possible cumulative effects, about possible undesirable outcomes, it is important to help them think through the implications of following their impulses or first inclinations.  As you do this, you and they may come to the conclusion that, in the present crisis, their best course of action is to “wait and see.”

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Please send comments or questions to Gary A. Crow, Ph.D. GAC@GaryCrow.net || and visit www.GaryCrow.net.