Simplifico mucho procesos históricos complejos en el ámbito de la deno­ minada ocupación de la tierra; cf M Clauss, G eschichte Israels, 31-39.

It is important to gauge the stages and completeness of the intervention to be able to evaluate whether crisis intervention was successful. According to Roberts (2005:20) his seven-stage model is a guide to the interventionist and not a rigid process; stages may overlap.

Figure 5.2: Roberts’s Seven–Stage Crisis Intervention Model (Adapted from Roberts, 2005:20)

5.5.1.1 Plan and conduct a crisis assessment

According to Roberts (2005:20), basic information needs to be obtained in order to Establish

follow-up plan

Develop an action plan

Generate and explore alternative

Deal with feelings and emotions

Identify major problems (Including the crisis precipitants)

Establish rapport and rapidly establish relationship

Plan and conduct a crisis assessment (Including Lethality Measures)

Crisis resolution

determine whether the person in crisis is safe or needs any medical attention. Any possible suicidal thoughts or previous attempts at suicide need to be evaluated to ensure that the client is safe and open to any intervention. This is important when working with bereaved mothers as well. If the mother has a previous history of major depression or suicidal thoughts, this needs to be taken into consideration when starting with crisis intervention. A stillbirth is such a sudden, overwhelming tragedy that it may trigger previous depression or suicidal ideations.

5.5.1.2 Establish rapport and rapidly establish a relationship

During initial contact it is important to establish rapport by conveying genuine respect for and acceptance of the client. The social worker needs to let the client feel that this is the place that she/he can get help. The social worker furthermore needs to indicate that he/she is trustworthy and willing to listen.

5.5.1.3 Examine the dimensions of the problem in order to define it

Roberts (2005:23) suggests that it is useful to identify the following: (i) the precipitating event that led the client to seek help; (ii) previous coping methods; and (iii) danger or lethality. The use of open-ended questions as a technique of counselling can be very effectively applied here. The focus must be on now and how, rather than then and why. A good example would be: “What situation or event led you to seek help at this time?”

5.5.1.4 Encourage an exploration of feelings and emotions

This is particularly important because some therapists overlook it in their attempt to make a rapid assessment and find the precipitating event. According to Roberts (2005:23) and Mahan and Calica (1997: 144) it is extremely therapeutic for a client to express feelings and emotions in an accepting, supportive, private and nonjudgmental setting. The primary technique for identifying a client’s feelings and emotions is through active listening. This involves the crisis worker/social worker listening in an empathic and supportive way to both the client’s reflection of what has happened and how the client feels about the crisis event. Redman (2003:731) is also of the opinion that support received by professionals is critical in the long-term adjustment of childbearing families coping with a stillbirth. Listening could prove to be more important that talking, and being there may be more important than doing. Hammersley and Drinkwater’s

(1997:584) views about stillbirth correlate with this viewpoint, that when the crisis worker listens to the bereaved mother, she feels that her feelings are acknowledged and that she is allowed to grieve about her stillbirth baby.

5.5.1.5 Explore and assess past coping attempts

As explained by Caplan (1964:39) one of the major focus points of crisis intervention involves identifying and modifying the client’s coping behaviours at both the preconscious and the conscious level. It is useful to ask the client how certain situations are handled, such as feelings of intense anger, loss of a loved one, disappointment or failure. Roberts (2005:23) suggests that solution-based therapy should be integrated into crisis intervention at this stage. This method emphasizes working with client strengths. It is important to help the client to generate and explore alternatives and previously untried coping mechanisms or partial solutions. If possible, this involves collaboration between the client and the social worker to generate alternatives. Most clients have some notion of what should be done to cope with the crisis situation, but they may well need assistance from the social worker in order to define and conceptualize more adaptive coping responses. A good example of this is the social worker working with the bereaved mother and helping her with ways in which to cope with her own feelings and how to react towards her other children and partner/husband. The social worker needs to identify what positive coping mechanisms she is already using and help her to expand on this.

5.5.1.6 Restore cognitive functioning through implementation of an action plan

Roberts (2005:24) explains that the crisis worker using a cognitive approach helps the client focus on why a specific event leads to a crisis state and what the client can do to effectively master the experience. When applied to stillbirth, the loss of the baby may leave a mother/couple to feel that their expectations have been violated. They were looking forward to become parents and have been dreaming of this for some time. In order to help the client understand why she is in a crisis and how to handle it from a cognitive approach, the worker needs to explain the three phases of cognitive mastery as mentioned below.

- The client needs to obtain a realistic understanding of what happened, why it happened, who was involved and the final outcome.

- The client needs to understand the event’s specific meaning: how it conflicts with his or her expectations, life goals and belief system.

- The final part of cognitive mastery involves restructuring, rebuilding, or replacing irrational beliefs and erroneous cognitions with rational beliefs and new cognitions. When these phases are to be put in practice after a stillbirth, the first phase normally takes place when the social worker listens to the bereaved mother/couple telling their story of what exactly happened, who was involved (family and medical personnel) and how they were treated. This is essential so that the couple can understand the full implications of the stillbirth. Next, the conversation must focus on the impact of the stillbirth and what it means for the couple not being able to reach a certain life goal of parenthood, for example. The skilled social worker should take note of any cognitive errors or distortions, like catastrophizing and irrational beliefs. Then the third phase needs to be implemented and the social worker needs to help the bereaved couple to restore rational beliefs and new cognitions. This correlates with the grief process where acceptance occurs.

5.5.1.7 Follow-up

The client should be told that if at any time she or he needs to come back for another session, the social worker will be available. It often happens that the clients cancel their second or third appointment before the crisis has been resolved. Clients often go into crisis at the anniversary of the trauma and then need help again.