Caplan's Phases in Crisis Development

Phase 1

• Individual is exposed to a precipitating stressor:
• Anxiety increases, previous problem-solving techniques are employed.

Caplan's Phases in Crisis Development

Phase 2

• Anxiety increases when previous problem-solving techniques don't relieve the stressor.
• Individual begins to feel discomfort, coping techniques are attempted - if failed helplessness, confusion and disorganization prevail.

Caplan's Phases in Crisis Development

Phase 3

• All possible resources (internal/external) are utilized to solve the problem and relieve discomfort.
• Individual may try to view problem from a different perspective.
• New problem-solving techniques may be used, if effective, resolution may occur at this point. Individual may return to a higher, lower level functioning.

Caplan's Phases in Crisis Development

Phase 4

• If resolution doesn't occur in previous phases "tension mounts beyond a further threshold/burden increases over time to breaking point. Major disorganization of the individual with drastic results often occurs"
• Anxiety may reach panic leaves, disordered cognitive functions, labile emotions, psychotic thinking behavior

Baldwin's Types of Crises

How many classes?

There are Six Classes:

• Class 1 - Dispositional Crises
• Class 2 - Anticipated Life Transitions
• Class 3 - Traumatic Stress
• Class 4 - Maturational/Developmental Crises
• Class 5 - Psychopathology
• Class 6 - Psychiatric Emergencies

Baldwin's Types of Crises

Class 1 - Dispositional Crises

• An acute response to an external situational stressor
• E.g. Ted has been having difficulties at work and became abusive with Nancy because dinner wasn't prepared on time.
• Intervention: Mental Health Counselor provided support, guidance and referrals for agency assistance were made.

Baldwin's Types of Crises

Class 2 - Anticipated Life Transitions

• Normal life-cycle transitions that may be anticipated but over which the individual but over which the individual may feel a lack of control.
• E.g. College student J.T. is on probation because of low grades, he is working increased hours. He presents to the student health nurse with physical symptoms.
• Intervention: Perform physical examination, ventilation of feelings should be encouraged, provide reassurance & support. Refer to services and identify problems and tackle change approaches.

Baldwin's Types of Crises

Class 3 - Traumatic Stress Crises

• Crisis precipitated by an unexpected external stressor over which the individual has little or no control and as a result of which he or she feels emotionally overwhelmed and defeated.
• E.g: Sally is a waitress whose shift ends at midnight, she got attacked and raped. After physical wounds healed, Sally is fearful, relives flashbacks and dreams, can't eat, sleep or work, needs an escort.
• Intervention: Nurse should encourage Sally to talk about the experience and encourage her to express her feelings. Nurse should offer reassurance, support, and discuss stages of grief and how rape cause a loss of self-worth. Identify support systems and explore new methods of coping with emotions arising from situation.

Baldwin's Types of Crises

Class 4 - Maturational/Developmental Crises

• Crises that occur in response to situations that trigger emotions related to unresolved conflicts in one's life. These crises are of internal origin and reflect underlying developmental issues that involve dependency, value conflicts, sexual identity, control and capacity for emotional intimacy.
• E.g: Bob, 40 years - has been passed over for a job promotion for a third time, his father was domineering and became abusive when Bob didn't comply. This 3rd rejection created feelings of depression & anxiety.
• Intervention: Primary intervention is to help Bob identify unresolved developmental issue that is creating conflict. Support & guidance are offered during initial crisis and then assistance is given to help Bob work through underlying conflict to change response patterns that are creating problems in his current life situation.

Baldwin's Types of Crises

Class 5 - Psychopathology

• Emotional crises in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution e.g. personality disorders, anxiety disorders, bipolar disorder, schizophrenia.
• E.g: Sonja diagnosed w/ borderline personality is told her long time therapist is moving across the country with her new husband, Sonja feels distraught and abandoned - she is found disoriented and wandering on a busy road.
• Intervention: initial - decrease anxiety felt, needs someone stay with her and reassure her of safety and security. She should then be encouraged to verbalize feelings of abandonment
• Discourage regressive behaviors, refer to longterm care if necessary.

Baldwin's Types of Crises

Class 6 - Psychiatric Emergencies

• Crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility. e.g. suicidal cases, drug overdoses, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger and alcohol intoxication.
• e.g. Jennifer overdoses on valium because Joe dumps her the night of an aftergame party.
• Intervention: Monitor VS, airway, gastric lavage w/ charcoal. Transfer to psychiatric unit, patient should be encouraged to express feelings of rejection and overdose. Conduct family therapy sessions and work with patient to develop individual adaptive methods.