Effective problem-solving in a crisis

Crisis. What comes to mind when you hear this term? Do you think of natural disasters such as hurricanes, national health concerns like the Ebola virus, personal struggles such as a divorce or failed relationship, or perhaps something less dramatic but still emotionally draining such as failed expectations or loss of a good job. Whatever the stressor (a situation that outweighs your ability to cope with it), a crisis can be any of the above situations and be long-term or short-term. 

A crisis has been defined in multiple ways but most people define a crisis as a hazardous event that outweighs your ability to cope. Such a situation could include physical stressors (lack of sleep, poor nutrition, medication changes, or an illness), emotional/psychological stressors (anxiety, depression, worrying, cognitive distortions, etc.), and social/environmental stressors such as overcrowded living conditions, socioeconomic status, living in high crime or drug infested areas, lack of income, loss of a job, poor interpersonal relationships, lack of education, or no transportation. All of these things can become a  crisis because each individual is different and each individual’s ability to cope is also different. What might be a crisis to you might not be a crisis to someone else. This is why it is important to exercise empathy and compassion when someone is feeling as though they are in a crisis state.

A lot of people question whether a crisis is also an emergency. Believe it or not, an emergency is not necessarily a crisis but it can escalate into an emergency. An emergency is a life-threatening event that requires immediate attention, while a crisis is a state of disequilibrium or imbalance that might require emergency attention if the individual within the crisis needs help such as in the case of having suicidal thoughts, cutting, or threatening to kill someone. For example, a woman who is holding a gun to her head and threatening to take her life, is not in a crisis but an emergency because this is a life-threatening situation. The crisis has already occurred in this situation which is why the individual is now in a state of emergency. The crisis, again, can be anything from lack of income to divorce or lack of family support to loss of job. Being hospitalized can also be a crisis situation.

As a therapist working with severely mentally ill and behaviorally ill children, I see crisis all the time which often puts me in a state of emotional and psychological “crisis.” This requires that I use coping skills and tools that have helped me in the past such as shopping or listening to music or engaging in Zumba. Parents, caregivers, friends, and other family members can also be forced into a state of “crisis” living with and trying to cope with a loved one’s mental illness. As a result, it is important to employ coping skills or “coping resources” such as:

1. Social support (from agencies, organizations, or people you trust).
2. Psychological/emotional support (things you can do to help yourself or elf-regulate such as listening to music, shopping, eating healthy, exercising, etc).
3. Environmental support (traveling, changing your scenery, changing or adjusting your friends, moving, etc).

Coping skills are great ways to try to re-gain your strength and perspective. If you continue on in a state of crisis without any support, you can end up needing emergency help.

Another great way to cope with crisis-type situations is to learn how to problem-solve effectively. One of the things many of my young clients complain about is the fact that they don’t know what to do. This state of helplessness is a crisis state that could lead to an emergency such as suicidal thinking. When my clients feel they have no control over their situation and that there is nothing they can do, their crisis gets bigger and bigger and more and more overwhelming. It’s often very useful to talk to a trusted friend, therapist, pastor, or other support that can help you problem-solve. I use a specific outline for my kids in session which includes the following:

• Identifying the problem (discussing what the problem is and why it is a problem)
• Identifying past behaviors or approaches that didn’t work or that ended in disaster
• Developing a different response that might turn out better
• Find ways to take baby-steps in implementing this solution
• Consider what can or who can support you in trying this new solution or different response
• Ask for feedback once you have tried the different response (asking others if they think your approach was better)
• Trying it all out
• Evaluating it (determining if it actually worked)

Consider this situation from one of my sessions this past week:

Kimberly is a 12 year old girl who is in treatment for depression and severe anxiety. She lives in a lower socio-economic neighborhood that consists of crime and drug abuse. Her mother is an alcoholic who binge drinks every weekend with her new boyfriend of 4wks. Every weekend Kimberly’s mother struggles to stay away from the alcohol. Her mother has been on disability for 15yr for bipolar disorder and for a heart condition. Kimberly’s mom doesn’t have transportation to take her to school each day so she is stuck walking to school with kids who are either bullying her, threatening to bully her, or pressuring her to try drugs with them after school. Kimberly is feeling overwhelmed by her own mental health problems and environmental stressors. Once in school, she finds herself struggling with anxiety and asks her teacher to allow her to sit in the back of the class alone. Her teacher, who has been in the army for years, tells her to “suck it up” and “hang in there with the other students.” She tries to explain that her anxiety and depression have worsened due to changes in her home life and that she needs a little flexibility. She tries to convince her teacher that she will complete her work but just cannot participate actively in class at this time. Her teacher sends her to the Principals office and she gets a rating on her report card of “failing to participate.” Her mother begins to yell at her and sends her to her room. Kimberly sits in her room, having already been in crisis state, and contemplates suicide. She grabs a pocket knife and begins to cut her arms and legs. Her mother just happens to walk into her room and see blood. Mother calls 911 and reports that her daughter needs psychiatric treatment. The police call an ambulance that eventually takes Kimberly to the nearest psychiatric hospital for evaluation. The attending psychiatrist diagnosed Kimberly with major depressive disorder, severe, single episode. She is then held in the hospital for 48-72hrs before obtaining an appointment with an outpatient therapist. Her therapist further evaluates her, designs a crisis plan with Kimberly, and begins to discuss problem-solving skills. Kimberly explains that she does not have control over her situation because her mother “does what she wants to do and I am just a kid.” Her therapist explains that while she may not have complete control over her circumstances, she can use problem-solving skills that can help her cope in the meantime. The therapist explains that instead of engaging in self-injury as a coping skill, she can turn to self-soothing to calm down (listening to music, exercising, talking to a friend, dancing, etc.) and then walk through the problem-solving stages:

• Identify the problem: too many changes in the home, declining mental health, lack of understanding teachers
• Past responses that didn’t work: cutting, thinking about suicide (which resulted in being hospitalized and medicated)
• Develop a different plan: use coping skills first, reach out to someone for help that might understand you better such as a school counselor or Principal.
• Find ways to take baby-steps in implementing this solution: each time Kimberly feels overwhelmed, she is to try one coping skills per day and then increase the amount of coping skills she uses each week.
• Consider what can or who can support you in trying this new solution or different response: talking to a school counselor or the Principal about the coping skills you need to use in order to stay on track in school. Kimberly asked me to write a note to her school’s Principal and teacher so they could better understand the situation.
• Ask for feedback once you have tried the different response (asking others if they think your approach was better): after a week of trying her new skills, Kimberly is to ask her teachers if they saw a difference in her.
• Trying it all out: Kimberly set her mind on giving this process a try without fighting it or making excuses for why it won’t work.
• Evaluating it (determining if it actually worked): Kimberly will write in her journal or talk with her teacher about how these skills help or do not help.

Most kids feel that this process is very long and useless. Of course, I can see how! But the key is having an open mind during a crisis and finding ways to cope. I encourage you to try this process with a client, student, or loved one that might be in crisis state.

As always, I wish you the best!