Estudios del comportamiento del crédito

As far back as 400B.C., physicians have stressed the significance of crisis as

a hazardous life event. Hippocrates himself defined a crisis as a sudden state that gravely endangers life. But the development of a cohesive theory of crisis and approaches to crisis management had to await the twentieth century. The movement to help people in crisis began in 1906 with the establishment of the first suicide prevention center, the National Save-a-Life League in New York City. However, contemporary crisis intervention theory and prac- tice were not formally elaborated until the 1940s, primarily by Erich Linde- mann and Gerald Caplan.

Lindemann and his associates at Massachusetts General Hospital intro- duced the concepts of crisis intervention and time-limited treatment in 1943

in the aftermath of Boston’s worst nightclub fire, at the Coconut Grove, in which 493 people perished. Lindemann (1944) and colleagues based the cri- sis theory they developed on their observations of the acute and delayed reactions of survivors and grief-stricken relatives of victims. Their clinical work focused on the psychological symptoms of the survivors and on pre- venting unresolved grief among relatives of the persons who had died. They found that many individuals experiencing acute grief often had five related reactions:

1. Somatic distress

2. Preoccupation with the image of the deceased 3. Guilt

4. Hostile reactions

5. Loss of patterns of conduct

Furthermore, Lindemann and colleagues concluded that the duration of a grief reaction appears to be dependent on the success with which the be- reaved person does his or her mourning and “grief work.” In general, this grief work involves achieving emancipation from the deceased, readjusting to the changes in the environment from which the loved one is missing, and developing new relationships. We learned from Lindemann that people need to be encouraged to permit themselves to have a period of mourning and eventual acceptance of the loss and adjustment to life without the parent, child, spouse, or sibling. If the normal process of grieving is delayed, negative outcomes of crises will develop. Lindemann’s work was soon adapted to interventions with World War II veterans suffering from “combat neurosis” and bereaved family members.

Gerald Caplan, who was affiliated with Massachusetts General Hospital and the Harvard School of Public Health, expanded Lindemann’s pioneering work in the 1940s and 1950s. Caplan studied various developmental crisis reactions, as in premature births, infancy, childhood, and adolescence, and accidental crises such as illness and death. He was the first psychiatrist to relate the concept of homeostasis to crisis intervention and to describe the stages of a crisis. According to Caplan (1961), a crisis is an upset of a steady state in which the individual encounters an obstacle (usually an obstacle to significant life goals) that cannot be overcome through traditional problem- solving activities. For each individual, a reasonably constant balance or steady state exists between affective and cognitive experience. When this homeostatic balance or stability in psychological functioning is threatened by physiological, psychological, or social forces, the individual engages in problem-solving methods designed to restore the balance. However, in a cri- sis situation, the person in distress faces a problem that seems to have no solution. Thus homeostatic balance is disrupted, or an upset of a steady state ensues.

Caplan (1964) explains this concept further by stating that the problem is one in which the individual faces “stimuli which signal danger to a funda- mental need satisfaction . . . and the circumstances are such that habitual problem-solving methods are unsuccessful within the time span of past ex- pectations of success” (p. 39).

Caplan also described four stages of a crisis reaction. The first stage is the initial rise of tension that comes from the emotionally hazardous crisis- precipitating event. The second stage is characterized by an increased level of tension and disruption to daily living because the individual is unable to resolve the crisis quickly. As the person attempts and fails to resolve the crisis through emergency problem-solving mechanisms, tension increases to such an intense level that the individual may go into a depression. The per- son going through the final stage of Caplan’s model may experience either a mental collapse or a breakdown, or may partly resolve the crisis by using new coping methods. J. S. Tyhurst (1957) studied transition states—migra- tion, retirement, civilian disaster, and so on—in the lives of persons experi- encing sudden changes. Based on his field studies on individual patterns of responses to community disaster, Tyhurst identified three overlapping phases, each with its own manifestations of stress and attempts at reduc- ing it:

1. A period of impact 2. A period of recoil

3. A posttraumatic period of recovery

Tyhurst recommended stage-specific intervention. He concluded that per- sons in transitional crisis states should not be removed from their life situa- tion, and that intervention should focus on bolstering the network of rela- tionships.

In addition to building on the pioneering work of Lindemann and Caplan, Lydia Rapoport was one of the first practitioners to write about the linkage of modalities such as ego psychology, learning theory, and traditional social casework (Rapoport, 1967). In Rapoport’s first article on crisis theory (1962), she defined a crisis as “an upset of a steady state” (p. 212) that places the individual in a hazardous condition. She pointed out that a crisis situation results in a problem that can be perceived as a threat, a loss, or a challenge. She then stated that there are usually three interrelated factors that create a state of crisis:

1. A hazardous event 2. A threat to life goals

3. An inability to respond with adequate coping mechanisms

In their early works, Lindemann and Caplan briefly mentioned that a hazardous event produces a crisis, but it was Rapoport (1967) who most thoroughly described the nature of this crisis-precipitating event. She clearly

conceptualized the content of crisis intervention practice, particularly the initial or study phase (assessment). She began by pointing out that in order to help persons in crisis, the client must have rapid access to the crisis worker. She stated: “A little help, rationally directed and purposefully fo- cused at a strategic time, is more effective than more extensive help given at a period of less emotional accessibility” (Rapoport, 1967, p. 38).

This point was echoed by Naomi Golan (1978), who concluded that dur- ing the state of active crisis, when usual coping methods have proved inade- quate and the individual and his or her family are suffering from pain and discomfort, a person is frequently more amenable to suggestions and change. Clearly, intensive, brief, appropriately focused treatment when the client is motivated can produce more effective change than long-term treatment when motivation and emotional accessibility are lacking.

Rapoport (1967) asserted that during the initial interview, the first task of the practitioner is to develop a preliminary diagnosis of the presenting problem. It is most critical during this first interview that the crisis therapist convey a sense of hope and optimism to the client concerning successful crisis resolution. Rapoport suggested that this sense of hope and enthusiasm can be properly conveyed to the client when the interview focuses on mutual exploration and problem solving, along with clearly delineated goals and tasks. The underlying message is that client and therapist will be working together to resolve the crisis.