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Some crisis situations are personal, such as the death of a loved one or being the victim of a rape, a robbery, or a severe battering incident; others are

triggered by a sudden, community-wide traumatic event, such as an airplane crash, flood, hurricane, terrorist attack, or tornado. Both individual and community-wide traumatic events can cause widespread crisis for dozens, hundreds, or even many thousands of people.

Secondary Victims in the Aftermath of the World Trade Center Terrorist Attack on September 11, 2001

Shelley is a 20-year-old college junior whose uncle was one of the 343 brave NYFD firefighters who died trying to rescue people trapped in the carnage of the Twin Towers at the World Trade Center on the morning of September 11. Shelley was very close to her uncle and grew up two blocks away from him and his family on Staten Island. Shelley’s mother was the sister of her deceased uncle. Uncle Frank had three kids, two at colleges in North Carolina and Massachusetts, and a third, Samantha, who was only 10 years old at the time. Samantha’s father used to take her to work with him in the morning, where she would have breakfast with the other firefighters, and then her dad would drop her off at school, which was near the firehouse in Staten Island. Shelley was very supportive of her own mother, her widowed aunt, and her 10-year-old cousin and did her best to help with their immediate concrete and crisis needs.

Since returning to NYU in lower Manhattan, Shelley has had difficulty concentrating, has nightmares and gets only a few hours sleep each night, and is anxious about her grades and graduation. Shelley speaks to her mother or aunt almost every day after her classes. She also attended her Uncle Frank’s funeral and wake, as well as two memorial services. In addition, Shelley and other members of her immediate family watched the television coverage re- peatedly after the terrorist attacks. Shelley seems to be overwhelmed emotion- ally by her grief-stricken aunt and young cousin as well as the intrusive thoughts and nightmares she has of the television images of the collapse of the Twin Towers and the aftermath of the rescue efforts. Some days she cuts all classes and completely withdraws and isolates herself in her dorm room.

Shelley goes to the university counseling center on referral from her aca- demic advisor. However, she is very quiet and withdrawn due to her de- pressed mood and crisis reactions.

Sudden Death of a Spouse and Child

Joe begins to barbecue the hamburgers for tonight’s dinner. His wife and their two daughters are expected home in about 20 minutes. His older daugh- ter had a track meet, and his wife and younger daughter went to watch her. The phone rings, and Joe is informed by a police officer that his wife and older daughter have been killed by a drunken driver who sped through a red light and smashed into their car two blocks from their house. His life will never be the same.

Deaths and Injuries Related to Plane Crash

At 9:00 A.M.one morning, the pilot of a malfunctioning air force attack jet tried unsuccessfully to make an emergency landing at Indianapolis Interna- tional Airport. The out-of-control jet clipped the top of a nearby bank build- ing, then rammed into the lobby of a Ramada Inn and exploded, killing 10 people and injuring several others. This tragic accident resulted in hundreds of persons in crisis: those injured in the explosion, the family members of the dead and injured, the guests and surviving employees at the hotel who wit- nessed the horror, and the employees and customers at the bank building that was struck by the plane, even though no one at the bank was physically hurt.

Woman Battering

Judy B., a 27-year-old surgical nurse, was a survivor of wife battering. She and Ray had been married for 6 years, and they had two children. As Ray’s drinking increased, so did his beatings. The final straw was a violent attack in which Ray punched Judy many times in her face. The day following this last assault, after looking at her swollen face in the mirror, Judy went to a gun store and purchased a handgun. As she drove home looking at the gun by her side, she finally decided to seek help. She called the battered women’s shelter hot line and said, “I’m afraid that I’m going to kill my husband.”

Forcible Rape

Mary R. was a 22-year-old college senior when she was raped. At 11 P.M.

one evening Mary had just left the health sciences library at the university and was walking the three long blocks to the parking lot where her car was parked. She recalls her reactions a week later: “I was sort of in shock and numb. It was a terrifying, painful, and degrading experience. It was some- thing you don’t expect to happen. But it could have been much worse. He held a knife to my throat while raping me. I thought he was going to kill me afterward. I’m glad to be alive.”

Robbery

John A., a 24-year-old blind male, was a victim of robbery. John was return- ing to his apartment in the Bronx following an afternoon appointment with his physician when he was robbed. John recalled what took place: “A guy came up to me and pressed the cold barrel of his gun on my neck. He said if I don’t give him what I got he would shoot me and the dog. I gave him the $21 I had. Nobody helped me. Everybody’s afraid to intervene. They’re afraid because they know the guy will get off or be put on probation and may come after them.

About a week after the robbery, I woke up sweating and had a serious asthma attack. I was hospitalized for a week. Now I try not to visit friends or my cousin in Manhattan. I go out a lot less. I stay home and listen to the radio or TV most of the time.”

Broken Romance, Depression, and Alcoholism

Liz, a 21-year-old college senior, is very depressed. She and her fiance´ have just broken up, and she feels unable to cope. She cries most of the day, feels agitated, and isn’t sleeping or eating normally. Since the beginning of the relationship a year ago, Liz has become socially isolated. Her family strongly dislikes her fiance´, and her fiance´ discouraged her from spending time with her friends. Liz now doubts that she will find a job upon graduation in 3 months and is considering moving home. She comes from a large family, with parents who are very much involved with the other children. Thoughts of moving back home and losing her independence, as well as the broken ro- mance and the lack of a support system, have immobilized Liz, who has cut all her classes for the past week. She has not talked with friends or family about the breakup, and she is “holed up” in her room in the dormitory, drinking herself into a stupor and refusing to eat or leave the building even for a walk.

Shelley, Joe, Judy, Mary, John, and Liz are experiencing crisis reactions in the aftermath of highly stressful hazardous events. The initial crisis reac- tion in the aftermath of the sudden death of a loved one or being the victim of a violent crime is usually a series of physiological and emotional reactions. Some common reactions and symptoms after traumatic and crisis events in- clude overwhelming feelings of anxiety, despair, and hopelessness, guilt, in- tense fears, grief over sudden losses, confusion, difficulty concentrating, powerlessness, irritability, intrusive imagery, flashbacks, extreme suspicious- ness of others, shame, disorientation, loss of appetite, binge drinking, sleep disturbances, helplessness, terror, exhaustion, losses or lapses of religious beliefs, and/or shattered assumptions about personal safety. Persons experi- encing traumatic events or an accumulation of stressful life events usually attempt to understand and reduce their symptoms, to regain control of their environment, and to reach out to their support system (e.g., a significant other). Sometimes the person’s internal and external coping methods are successful, and an acute crisis episode is averted; at other times vulnerable individuals and groups fail in their attempts to cope, and crisis episodes escalate.

Chapters 1 through 5 of this book link crisis theory to practice. The empha- sis in the first five chapters is placed on the application of individual and group crisis intervention paradigms and models to facilitating crisis resolu- tion. Chapter 1 links the past to the present state-of-the-art knowledge of conceptualizing crisis theory, crisis reactions, and crisis intervention prac- tices. Chapter 2 focuses on how-to conduct lethality/danger assessments and apply each of the seven stages of the crisis intervention model to 3 individu- als with different degrees of suicide ideation presenting to a crisis center or psychiatric screening unit. Chapter 3 integrates Roberts’s seven-stage crisis

intervention model with solution-based therapy and a strengths perspective. Chapter 4 delineates and examines a stress, crisis, PTSD Classification Para- digm which provides guidelines for practitioners to effectively assess the se- verity of initial event, diagnostic symptoms, and treatment planning options. Chapter 5 develops a continuum of stress and crisis episodes ranging from low-level somatic distress to cumulative and catastrophic acute crisis epi- sodes.

Chapters 6, 12, 15, through 30 apply Roberts’s seven-stage model of cri- sis assessment and intervention to particular high-risk groups and situations such as the following:

• persons experiencing the loss of a loved one at the World Trade Center and the Pentagon on September 11th

• early adolescents who have experienced a significant loss • adolescents and adults with suicidal ideation and plans • child and adolescent psychiatric emergencies

• crises on the college campus • battered women in crisis

• crisis related to separation, divorce, and child custody • HIV-positive women in crisis

• persons in medical crisis presenting at the emergency room

• persons presenting with life-threatening injuries at a hospital emergency room

• persons experiencing psychiatric crises and coming to the local mental health center or emergency room

• a series of crises experienced by substance abusers

• people experiencing mental health–related crises and being helped by a frontline 24-hour mobile crisis team

• persons in crisis as a result of the burden of caring for a terminally ill or disabled parent

This is the first comprehensive handbook to consistently apply a comprehen- sive seven-stage crisis intervention model to a wide range of clients in acute crisis.

SCOPE OF THE PROBLEM AND