Crisis Counseling

History of Crisis Counseling

It has only been within the past 60 years that crisis intervention has grown into a field of its own with specific theories and techniques. Groundbreaking work by Erich Lindemann with the survivors of the Boston Cocoanut Grove fire of 1942 and Gerald Caplan's extension of that work forms much of the foundation for crisis intervention. Two historical events in the 1970s hallmark the birth and evolution of crisis intervention as a clinical specialty. The first was the Vietnam War and the perplexing psychological trauma that veterans carried out of it. The second was the women's movement that exposed domestic violence in its many forms. It became clear that no one is immune from the severe emotional distress and psychological disequilibrium that could result from exposure to traumatic events.

There are numerous factors that stand out as influencing the growth of crisis intervention as a clinical subspecialty.

• Suicide. The possibility of dealing with suicidal clients is ever present and is prevalent in all age and racial/ethnic groups. The resulting development of early research on the causes of suicide and suicide intervention techniques by Edwin Shneidman has been one of the seedbeds from which the fertile field of crisis intervention has grown.
• Crisis lines. The advent of telephone crisis and hotlines and, recently, the Internet, has made mental health services available to vast numbers of people who would otherwise be unable or unwilling to avail themselves of mental health services. The ease of access, constant availability, lack of cost, and anonymity of the caller have made the crisis line the most used form of crisis intervention in the world.
• Interpersonal violence. The discovery that more unreported or underreported interpersonal violence takes place than what was previously thought has brought this large crisis population to the attention of counselors. Interpersonal violence has far-reaching effects for the survivors that occur long past the original incident itself and form the basis for what may be called transcrisis states.
• Substance abuse and drug addiction. The rise of substance abuse and the smorgasbord of both prescription and illicit drugs are a fertile breeding ground for personal, interpersonal, and community crisis.
• Posttraumatic stress disorder. In the last four decades, posttraumatic stress disorder (PTSD) has become identified as a major mental health problem. In a world where natural disasters and human-made traumatic events occur on an everyday basis, counselors have realized that those events leave a long and wide wake of residual stress.
• The mentally ill on the streets. With the advent of psychotropic drugs in the 1960s, it was believed that a significant turning point had occurred in the world of mental illness. It was felt that the antipsychotic drugs would allow the large, residential, state mental hospitals to be replaced with less-restrictive community mental health clinics and halfway houses. Unfortunately, this has not happened. The negative side effects of antipsychotic medication and the lack of adequate supervision have influenced the chronically mentally ill to stop taking their medication. Psychotic symptoms quickly resurface and are further compounded when individuals use alcohol or illicit street drugs. These “dual diagnosis” clients may then have very severe and violent psychotic breaks with reality. They also may become a large part of the homeless population. As a result, police departments have become unwilling participants [Page 546]in the community mental health business as they attempt to contain these mentally ill individuals. Indeed, one of the largest groups of professionally trained crisis interventionists is specially trained police officers who operate on Crisis Intervention Teams.

Theories of Crisis Intervention

Crisis intervention theory is in its infancy. To date, emphasis has been on helping people recover from crisis situations rather than on theory development. However, a number of experts in the field have recognized this shortcoming and are beginning to build theoretical models for understanding crisis intervention. Their research focuses on including and using contextual issues that influence individuals' reactions in crises. These researchers are integrating ideas from systems, adaptional, interpersonal, and ecological approaches to understand crisis intervention.

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