Crisis Intervention: A Social Interaction Approach (3)
In considering the now potential in crisis, emphasis is first given to the “potential,” which refers to what might or could happen. What is the worst possible outcome of the crisis? Could the individual or someone else in his total situation die? Could someone get hurt? Could there be some other similarly serious consequence? Could the individual’s situation become so deteriorated or so permanently messed up that no amount of help or concern could return it to its pre-crisis state? The potential of the crisis lies somewhere between no bad consequences or effects and the serious injury or death of someone in the total situation.
The “now” in the now potential refers to the immediacy or emergency quality of the crisis. We need to know how quickly things might deteriorate or get worse. How quickly might the potential be actualized? Will it take a week, a few days, a few hours, or could the worst possible outcome occur almost immediately? This “how soon” is the “now” in the now potential. As we intervene into crises by trying to find out what happened and by developing a picture of the individual, his total situation, and the interaction between the two, we simultaneously need to consider and develop a judgment about the now potential of the crisis. How bad could it get? How soon?
Let me tell you about a situation out of my own experience. It seemed, at the time, like a real crisis. Looking back, the obvious flaw in my judgment was my failure to recognize that the now potential was very nearly approaching zero. The summer between my first and second years in graduate school was spent as a program director at a YMCA camp. About ten-thirty one evening, I was sitting in the dining hall with most of the camp staff, trying to make time with the camp cook. (I married her a couple of years later and am still married to her; so that worked out pretty well.) At any rate, it was girls’ camp that week, and all the campers and staff were girls (except for one college-age boy who helped in the kitchen and the camp director, who was gone that night). Sure! I thought it was great.
One of the younger counselors and two of her friends came running into the dining hall in near hysteria, and about all we could get out of them for a minute or two was “He’s dead. It’s a dead body.” They had tripped over what they thought to be a dead body on the footbridge across the river. With some embarrassment, I must admit that I became nearly as panicked as the girls. It seemed like a real crisis; I really do not want to go into the details that led to four police cars and seven deputy sheriffs being in camp. Remember the guy who helped in the kitchen? Well, it seems that he and his girl friend….They had not moved when the kids tripped over them because they were not supposed to be out there in the first place. A crisis? I sure thought so at the time, but on looking back, I can see that even had there been a dead body on the bridge, the now potential was pretty low. Dead bodies tend to stay in place and not make much trouble. Also, the likelihood of a dead body on a bridge in a summer camp is fairly remote itself.
However, specific note must be made of crisis situations that should always be interpreted as holding high now potential. For example, any reference to suicide, whether or not it initially seems to be a serious report of someone’s intention to kill himself; any report of a strong impulse to abuse or physically injure a child; any report of a drug overdose; any report of bizarre or unusually strange behavior; or any report of a “bad trip” with drugs should always be seen as a serious crisis with significantly high now potential. Alternatively, reports of continuing but more serious marital difficulty, concerns about poor schoolwork or unsatisfying interpersonal relationships, continuing but more serious difficulty in managing or controlling the behavior of children, or experience involving a somewhat increased sense of discontent and restlessness should be seen as holding less significant now potential.
Since threats of suicide, comments about suicide, and situations in which suicide appears to be a significant possibility frequently come up in crisis intervention practice, some special comments about the dynamics of suicide are in order. First, the now potential in suicide situations is critically high. Clearly, someone could die. Later in this text, we will discuss situations and circumstances that can prompt people to feel like killing themselves. Here we want to think about what is going on within the individual when he is considering killing himself. Most typically, people who are suicidal appear to be extremely depressed, somewhat withdrawn, and express feelings of futility and despair. At other times, however, people may talk about suicide in a light and casual way. In some cases, references to suicide may be very indirect and not appear to be particularly serious.
Next, having recognized the high now potential in any suicide threat, we want to keep in mind the fact that people very rarely kill themselves in the presence of other people. This is true despite the sensational news coverage given to people who have shot themselves in front of their family or friends. Suicide is almost always a solitary act. It thus becomes important to make sure that a potentially suicidal individual is not alone. If he has come to our office or drop-in center, we will either stay with him or make arrangements for someone else to stay with him until the suicidal crisis has passed. If he calls us on the hot line, we will try to learn if he is home alone, if there is someone who could come over to stay with him, if there is some place he could go where there are people, and so on. If he has called us on the telephone and if we can get no assurance that he will go to a friend, we should make every effort to find out where he is. Once we know where he is, we will waste no time in getting someone to him.
A situation with a real and immediate possibility of suicide is one of the very few in which we would call in the police. If the only way to get someone to the individual is to have the police knock on his door, then we will have the police do that. If we have overreacted, however, the individual will probably never again place any faith and confidence in us. He will probably be very angry and may well say very negative and destructive things about us to his friends. The only way to avoid this is to run the risk of under reacting. To under react is to run the risk of having a dead client.
What has happened to the person who becomes suicidal? Clearly, he has turned his anger in on himself. This fact comes as a surprise to many newcomers to crisis intervention. Ask yourself, “What is the most angry, aggressive act an individual can carry out?” He can kill someone. There is probably no act more expressive of extreme anger than murder. Most people would not be able to kill unless they had temporarily lost their senses or had gone into a violent rage. This kind of intense anger is something most people would find difficult to express directly. Suppose, though, that they were angry with themselves for something they had done or something they thought they had done. Suppose this led to their feeling unable to cope with their life situation, face their family or friends, or otherwise deal with things. Since there is no way to work things out or to make things better, the anger turns in on the individual. At the extreme, that anger causes the individual to kill himself. Sometimes this intense anger may be focused on an individual, a member of the family, a friend, an associate, or on the world in general. Because the individual in crisis feels unable to take out his anger directly on someone or cope with his situation, he may take it out on himself. Whatever the reason or circumstances, suicide is always an expression of extreme internalized anger.
In the crisis intervention process, the goal in suicidal situations is to enable and encourage the individual to express his anger, talk about what has made him mad, verbalize his frustrations, and generally “get it out where he can deal with it.” Working with people in suicidal crises is difficult, but you will be able to help them. Your efforts should be to get them to externalize their anger, tell you what frustrates them, talk about things that have made them angry, deal with their resentments, think through the situations and relationships with which they feel unable to cope. If they can verbalize their anger, focus their bad feelings on specific people and situations, and make plans about coping with their life circumstances, they are well on their way to getting through the potentially critical crisis.