Crisis Intervention and Psychological First Aid

Abstract

Throughout this text, we have discussed the body and mind’s continuing struggle to maintain homeostasis. As the body struggles to maintain a physical homeostasis (Cannon, 1932), or “steady state,” so the mind struggles to maintain a similar balance. As a medical crisis is a state wherein physiological homeostasis has been disrupted with resultant physical distress and dysfunction, we then see the possibility of a psychological analogue. A psychological crisis is a response to a critical incident or distressing event wherein the individual’s psychological balance has been disrupted. There is, in effect, a psychological disequilibrium. This disequilibrium results because the individual’s usual coping mechanisms have failed. The predictable result is the emergence of evidence of acute psychological or behavioral distress coupled with some degree of functional impairment. More practically speaking, a crisis may be defined as a state of acute distress wherein one’s usual coping mechanisms have failed in the face of a perceived challenge or threat and there results some degree of functional impairment (see Caplan, 1961, 1964). This description argues more for an acute stress management-based intervention platform rather than traditional psychotherapeutic engagements. In 1952, F. C. Thorne wrote the following, “In our opinion, … preoccupation with depth psychology [psychotherapy] has had a very detrimental effect in causing us to overlook presenting complaints which may be very distressing to the client and about which he urgently wishes us to do something … Prophylactically, it is probable that many disorders could be nipped in the bud if prompt attention could be given to germinating seeds which may later grow into tall oaks … Diagnostically, one of our problems is to identify these emergency situations so that we can discriminate what needs to be done immediately…Therapeutically, much will be gained if the client can be made more comfortable even though no deep cure can be effected by first aid methods” (Thorne, 1952, p. 210). In this chapter, we shall examine crisis intervention and psychological first aid (PFA) as interventions that target acute distress seeking stabilization and acute mitigation rather than resolution and therapeutic growth.