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Case Example

Meredith, age 23, first met Willis, age 29, when he came to the apartment she shared with a roommate hairdresser, to have a haircut. According to Wil- lis, they felt an instant chemistry, and they began dating. From the beginning they isolated themselves from others, and when Meredith and her roommate parted, Willis asked Meredith to move in with him. Meredith ignored a nag- ging internal warning that this was not a good decision. For example, on their first date, Willis showed Meredith, a mental health counselor, his psychiatric record. She later said his diagnosis should have been a red flag to her: border- line personality disorder with antisocial, dependent, and passive-aggressive features. He also had a history of a drinking problem.

Willis believed he had found his future marriage partner; Meredith did not. After several months, she met another man she wanted to date and told Willis, whose reaction was worse than she imagined. He became depressed and began cutting himself and leaving blood on tissues around the apartment and writing “I love you” in blood on the wall. He begged her not to leave.

As Meredith began dating her new boyfriend, Willis obtained his address and telephone number. He began to write threatening letters. The boyfriend ended the relationship by leaving town. Willis continued to mail Meredith notes and greeting cards, pleading with her and then berating her. Detectives told Willis they could not arrest him, since his letters had been written before the new state stalking law took effect. They suggested he enter a psychiatric hospital.

Meredith left town, but within months Willis located her. She found a balloon and get-well card taped to her car and noticed two holes in the front windows of her apartment. When police arrested Willis, they found a stun

gun, rope, latex gloves, duct tape, and a pocketknife in his car. He pled no contest to his 16-month obsession with his ex-girlfriend.

Some emotional crises result from attempts to deal with primary interper- sonal situations that develop within the family or social network (e.g., rela- tional dysfunction). These relate back to developmental tasks and level 2 transitional crisis. If unresolved, the family crises reflect a struggle with a deeper, but usually circumscribed, developmental issue that has not been resolved adaptively in the past and that represents an attempt to attain emo- tional maturity. These crises usually involve developmental issues such as dependency, value conflicts, sexual identity, emotional intimacy, power is- sues, or attaining self-discipline. Often a repeated pattern of specific relation- ship difficulties occurs over time in those presenting with this type of crisis (Baldwin, 1978). The crisis may be directed internally or externally, as in chronic abuse.

Examples of family crises include child abuse, the use of children in por- nography, parental abductions, adolescent runaways, battering and rape, homelessness, and domestic homicide. The individual’s response to this level of crisis is chronic fear, an inability to protect the self and others, and a type of learned helplessness. The etiology of the crisis relates to the neurobiol- ogy of chronic trauma. There is often undisclosed relationship abuse and divided family loyalty.

In the case example, the potential dangerousness of the male partner, Willis, is clearly noted. His psychiatric diagnosis of personality disorder sug- gests an unresolved developmental power issue as noted by his stalking.

Research

It is important to note that every type of emotional crisis involves an interac- tion of an external stressor and a vulnerability of the individual. However, it is in level 4 crisis that there is a shift from a primarily external locus of stress that produces the crisis to an internal locus determined by the psycho- dynamics of the individual and/or preexisting psychopathology that becomes manifest in problem situations. Child abuse and battering within a domestic violence context are prime examples of family crises. Both are interpersonal situations that exist around long-term relationships. See chapter 20 for a review of the research on child abuse and crisis intervention.

Intervention

In family violence, the goals of intervention in level 4 crises are to help individuals restabilize their lives, strengthen their interpersonal relationships, and deter psychiatric symptomatology. First the crisis state, if there is one, must be resolved. All abuse must cease, and children and adults must be

safe. The survivors must adapt to immediate losses and changes created by the disclosure of abuse and the protective response by others. The dysfunc- tion in the family system must be addressed.

Roberts’s (1995, 1996) seven-step crisis intervention model is imple- mented. This model offers an integrated problem-solving approach to crisis resolution. The steps include assessing lethality and safety needs; establishing rapport and communication; identifying the major problems; dealing with feelings and providing support; exploring possible alternatives; assisting in formulating an action plan; and conducting follow-up.

Recovery services are to aid survivors in resolving the long-term issues. Stress reduction interventions are of two types: (a) those designed to help the individual prevent or manage stress, and (b) those aimed at eliminating or reducing the potency of the stressor. Techniques to consider include phys- ical activity to discharge repressed energy; nutrition therapy to enhance physiological recovery; spiritual support for persons who value religious be- liefs to promote a sense of integrity with the natural world; relaxation to counter hypervigilance; pleasure activities to promote a sense of fun and humor; and expressive activities such as reading, art, and music.

A variety of psychoeducational and therapeutic interventions have been developed to change perpetrator behavior, many of which have produced an actual decrease in violent or exploitive behavior. Generally, interventions include components designed to increase the knowledge and skills of the perpetrator with regard to anger control, mediation, communication, and family roles. See chapter 8 on domestic violence interventions.

Group models are often helpful. For example, narrative theory provides a useful framework for brief group treatment of persons in crisis because it proposes that understanding of experience is gained through social dis- course. Groups offer persons in crisis a new context for attributing meaning to critical events (Laube, 1998).