Our actual intervention is, surprisingly enough, the least complicated part of the intervention process, but it requires the most skill. Once we develop our intervention hypothesis, our actual intervention only involves following through with that hypothesis.
Some further comments related to intervention hypotheses may be helpful. Fundamentally, our intervention hypothesis in any given crisis can focus in only a few areas. As we discussed, we can focus on the individual and attempt to get him to calm down, slow down, and plan ahead. As varied as crisis situations are, this focus on the individual is by far the most common need in crisis intervention. Later we will discuss crisis communication as a way of responding to this kind of individual need. In addition to individual focus, our intervention hypothesis could relate to environmental modification or an attempt to change something or someone in the individual’s total situation. In some crises, we may want to focus our intervention hypothesis on the interaction between the individual and his total situation. At other times, we may want to direct our intervention hypothesis specifically toward reducing the now potential of the crisis. If a man tells you that he is going to kill himself, one of your first questions should relate to “how” he proposes to accomplish that. If he tells you that he is going to shoot himself with a gun that is lying on the table between the two of you, the now potential will be substantially reduced if you take the gun or at least make it inoperative. If a mother tells you she is afraid that she is going to injure one of her children severely, it would be wise to get someone else to watch the children for a while. What can you do or what can you get the individual to do, either to lower the now potential or to increase the self-resolution factor? Your answer to that question in any specific situation is your intervention hypothesis.
Throughout our discussion of crisis intervention, we have considered numerous examples of crisis situations and of people in crisis. Generally, intervention has been in terms of talking, thinking, responding to feeling, and helping the individual evaluate alternative plans of action. Intervention has been primarily a verbal, feeling process. There are, however, many crisis situations in which we should try to either get the individual to do something specific or do it ourselves. The example about the man who is going to shoot himself can serve to stimulate our thinking. If someone tells us that he is thinking about killing himself, we should always try to find out how he proposes to do that. If we are talking with someone on the hot line and he tells us that he is going to overdose with a bottle of tranquilizers he has in his bathroom, we will talk with him to try to get him to externalize and focus his anger. At some point in our conversation, we will hopefully get him to agree not to kill himself. If it is at all possible, we should get him to flush the tranquilizers down the toilet. If possible, we want him to lay the telephone receiver down, go flush the medication, and come back to the telephone to tell us that he has done it. Someone who is considering suicide in a serious way usually has a good idea about how he will do it. If the person no longer has the bottle of tranquilizers, he will at least have to think up a new way of killing himself if he again becomes acutely depressed after talking with us on the telephone.
If a young mother tells us that her child has accidentally swallowed some household cleaning fluid, we tell her to rush the child to a hospital emergency room. It is also important that we tell her to take the bottle or container with her. If an elderly person calls us and tells us that she is afraid that someone is trying to break into her house, the likelihood is that she has become lonely and somewhat upset. If she really thought someone were breaking in, she would probably have called the police instead of the hot line. Nevertheless, if we think that someone may indeed be trying to break in after we have talked with her for a few minutes, it would be a good idea to have her hang up, call the police, and then call us back. If a teenager calls us to inquire, for a friend, about the signs and symptoms of venereal disease, we want to give him full and complete information. In addition, we will want to make sure that he knows that venereal disease is potentially progressive; it can get much worse over a period of time. We want to be sure he understands that “his friend” should go immediately to the VD clinic or to his family doctor for an examination. If a young woman calls us for abortion information, we should be sure that she knows she should first be certain she is pregnant. It is surprising how many young women and teenage girls decide they are pregnant and make plans for an abortion without having a pregnancy test. One of our good friends may come to us quite upset, telling us about something he has heard about his wife. He has decided to file for a divorce on the strength of the rumor. We should encourage him to confront his wife directly with the information before doing anything drastic.
If we talk with an individual who seems to have overdosed himself with drugs and convince him to go to a hospital emergency room, we should be sure to call the emergency room and explain the situation before the individual gets there. If we refer someone to a welfare department, a mental health clinic, a physician, or other service, we should always call someone there and discuss the situation so that the agency has the benefit of our understanding and thinking. If a young child came into our office and told us that he was lost and asked us to call his parents for him, we would do it without hesitation. It is surprising, though, to hear of situations where children and teenagers have come to counselors, drop-in centers, emergency services, and so on, indicating that they are in some kind of desperate situation and asking if someone would call their parents and talk with them about the problem, only to be told, “We do not do that sort of thing. You will have to contact your parents yourself.” How do we, as crisis intervention workers, decide when it is okay for us to do something very specific? If it is something consistent with good ethical practice, we will do whatever needs to be done to help the individual through this crisis. The goal of crisis intervention is crisis reduction. The value framework underlying crisis intervention directs us to do whatever is reasonable and necessary to help the individual in crisis.