Crisis Counselling

Crisis counselling can be described as the form of counselling where “the immediate help that a
person in crisis needs to reestablish equilibrium” is offered. The primary purpose of crisis counselling
is to help an individual to restore some sense of control and mastery after a crisis event or disaster. It
is not unusual that in a crisis or disaster event, an individual’s normal coping capacities are taxed.
Individuals can become overwhelmed emotionally and may have difficulty with problem solving and
other coping skills.

Crisis counselling is directive and has limited goals to ensure safety and promote overall stability. The
goal is to provide emotional support and concrete feedback/assistance for the individual. Crisis
counselling helps in solving the immediate problem and assists individuals in obtaining available
resources. The duration of crisis counselling can range from 15 minutes to 2 hours, whereas the
frequency of the counselling with the same person ranges from 1 to 3 times.

What is a crisis?

A person is in a state of crisis when he/she/they perceive “an event or situation as an intolerable
difficulty that exceeds their resources and coping mechanisms”. However, it should be noted that a
given event, such as losing one’s job may precipitate a crisis in some people but not in others.
Counsellors cannot determine what constitutes a crisis for their clients by assessing whether the event
would cause a crisis in their own lives. And it is important to realise that a crisis is sometimes caused
by an event that affects an important person in the client’s environment.

Some of the events that may precipitate a crisis are listed below;

- Death (suicide, homicide, accidental/natural death)

- Health and wellbeing (physical/mental illness, injury, disability, physical/sexual/psychological
abuse, substance abuse)
- Reproductive issues (unwanted pregnancy, stillbirth, miscarriage)
- Disruptions of intimate relationships (infidelity, separation, divorce)
- Violence (domestic, rape)
- Disruptions of work/school (job loss, strikes, academic failure)
- Natural and environmental disasters (storms, earthquakes, flood, fire)
- Financial emergencies and homelessness (bankruptcy, unexpected expense, investment loss,
theft/fraud)

Goals of crisis counselling

Goals of crisis counselling as per American Counselling Association are as follows:

1. Safety: Ensures that the individual is safe. If lethality existed before crisis counselling, this
risk has been reduced and resources, if available, have been provided.
2. Stability: Ensures the individual is stable and has a short-term plan which includes mastery of
self and the emergency or disaster situation.
3. Connection: Helps connect the individual to formal and informal resources and support.

Steps in crisis counselling

Patterson & Welfel have summarised the steps involved in crisis counselling, which are described
below:
Step 1: Establish a helping relationship

Basic relationship building skills including active listening, and the core conditions of empathy,
positive regard and genuineness form the bedrock on which any crisis intervention is built. Even
though the focus is on restabilising the client, the client needs to feel the support that grows from
being understood. The counsellor needs to maintain calm confidence and hopeful expectation which
will reassure the client . A direct statement such as “we will work something out that will help you
face this situation better” helps in boosting hope. What the client needs is a role model who is not also
overwhelmed by circumstances.

Step 2: Assure safety

Among the conditions that may bring a client to a crisis counselling are suicidal ideation or attempts,
homicidal ideation, threatened or actual attacks on oneself, and fear of hurting someone else. It is
important to ask direct, specific questions about these circumstances and to understand the plans that
have already been made. The counsellor should judge the situations based on the answers and if it
seems dangerous, measures need to be taken to include the family members, hospitalise the client and
to protect any intended victims. When the safety of a client or another person is a concern, the
counsellor should seek consultation with a supervisor or colleague.

Step 3: Conduct an assessment

In the assessment process, the crisis counsellor seeks information about the event that precipitated the
crisis, what the event means to the client, the client’s support system, and his/her functioning prior to
the crisis. The information will help the counsellor to decide the course of action - whether the
consequences can be reversed, whether the client’s own coping resources can be utilised for meeting
the challenge, who else might help and how, and what the counsellor may need to do. It is important
to understand how the client usually manages challenges and what skills are available to him/her. The
client may have strengths in different dimensions of coping skills - perceptual, cognitive change,
support networking, stress management and wellness, problem solving, description and expression of
feelings. Plans for action should be designed to maximise the client’s pre-crisis strengths.

Step 4: Give support

Assessing the client’s support system involves finding out who in the client’s environment cares what
happens to him/her and has a favourable opinion of the client’s worth. When the client’s self-esteem is
low, calling on such individuals to be attentive and provide comfort is important. If other support
persons are scarce, the counsellor can make it clear to the client that there is one person right here who
really cares. Plans should also be made so that emergency contacts can be made with the counsellor or
other staff personally, when the client does not have any other support.

Step 5: Assist with action plans

A crisis counsellor takes an active role and is more directive than in other forms of counselling. The
counsellor may have to temporarily ‘lend’ their ego function to the client as the latter’s ego function
has been inadequate in dealing with the challenge. The counsellor should help the client gain an
accurate cognitive understanding of the crisis before seeking a solution. The client and counsellor may
have to brainstorm to list all possible actions initially. Once the possible solutions are listed, the
counsellor encourages the client to select one or more actions that he/she feels capable of
accomplishing. The counsellor guides in developing a short term plan that will help the client get
through the immediate crisis, as well as making the transition to long term coping. Sometimes, the
plan may also involve referrals to other material sources of support, such as housing, food, clothing,
financial assistance, medical evaluation or legal advice.

Before concluding the crisis session, it is important to judge whether the client’s anxiety has
decreased, whether the client can describe a plan of action on his or her own, and where there is a
gleam of hope in his/her manner. It is useful to invite a support person to join the end part of the
counselling to ensure that adequate support is available.

Step 6: Arrange for follow-up

A follow-up meeting or telephone call should be arranged at a designated place and time to check on
the client’s progress toward resolution of the crisis. If the client has not begun to manage his/her
problem by this time, then recycling through any or all of the above steps may be done.

Where do crisis counsellors work?

Crisis counsellors can work in a variety of settings including telephone crisis counselling centres,
online/live chat crisis counselling forums, mental health clinics, humanitarian aid organisations,
university counselling centres, nonprofit community centres and private practice. Additionally, crisis
counsellors can also provide mobile services. In these cases, they directly work onsite near the
location of a natural or human-caused disaster. When major disasters occur, many mental health
professionals volunteer their time to provide crisis counselling services.