Updated: Aug 14, 2019
One of the most challenging aspects of crisis counseling is understanding and dealing with the visceral and emotional responses of both client and therapist to the crisis. As humans, we have basic physiological responses to stressful situations. When we find ourselves in a crisis situation, adrenaline floods the body, heart rate increases, breathing becomes shallow, and field of perception narrows. Often, in addition to these physiological effects on the body, when a person is in crisis emotions may also be running high. It can be difficult to work with a client or a family that is in a heightened emotional and physiological state.
This autonomic response to acute stress is known as “fight or flight”, “flooding” (Gottman) or “emotional highjacking” (Goleman). It can be difficult, if not impossible, for a counselor to reach a client on a deeper level in that moment as the person’s physiology is actively calling the shots. It goes back to Maslow’s hierarchy of need; when someone is in a state of acute stress the brain receives signals of danger, and reasoning is reduced to functioning on the most basic level of “find safety” by any means possible.
The first step then, in working with a client in crisis, is to reduce the stress in the situation and bring the client and the family to a place of physiological homeostasis. Crises can take many forms, but as a therapist, it is important to be well-versed in basic stress management and reduction techniques. Some of the most fundamental ones would be a) removing a client from a stressful situation, b) performing deep breathing techniques, c) teaching clients about the effects of the bodies’ response to stress, d) helping them become aware of their own indicators of "flooding" and, e) how to practice their preferred calming techniques.
It can also be useful to incorporate a “time out” period in session where, if you notice clients becoming flooded, stop and ask clients to monitor their breathing and heart rate for a few minutes and give biofeedback. This exercise can help clients who are dysregulated become more aware of the effects their emotions are having on their physical bodies and is a technique they can easily incorporate and practice at home.
On the flip side of this equation is the person of the therapist. Emotional responses can be “contagious” and it is important for the therapist to have a good grasp on their own emotions and awareness of their responses to a crisis situation. Often if a therapist lets him or herself become flooded by the clients’ response to a situation, boundaries can get crossed, mistakes in treatment can occur, and the therapeutic relationship can be irrevocably damaged. It is therefore important for the therapist to be well aware of his or her own triggers and to know their own limits and capabilities. Setting limits and holding boundaries is a positive sign that the therapist is following best practices. This will help the therapist ethically decide when to refer or what populations and issues to avoid or limit working with.
Additionally, it is important for the therapist to be aware of his or her own biases, self-held beliefs, and values. Sometimes what the therapists perceives to be the cause of the crisis may not be what the family or client knows to be the cause. Monitoring your own responses and implicit biases as a therapist is extremely important for getting out of your own way in therapy. Maintain a curious stance. Maintain stability in chaos.
Having a strong support system professionally and having a stable home life personally is also important when working with clients in crisis. A therapist that becomes "emotionally hijacked" along with his or her clients cannot provide the best therapeutic care and will very quickly become depleted. Burnout is a major issue in any helping profession, but the antidote is to continue to practice self-care, continue to take self-inventory, and stay self-aware and honest about your limitations and needs as a therapist.
Some clients and crises will affect you more than others, but knowing and maintaining your boundaries is a big part of self-care. Sometimes it is hard to leave the work at the office, particularly in this profession, but maintaining a proper work-life balance is paramount to ongoing healthy functioning.
Cultivating a community of support in the therapeutic community to consult with and refer to if necessary can also be helpful. Maintaining intrapersonal stability is an important factor in being able to work with individuals and families in crisis. It is important to remember that by maintaining healthy boundaries as a therapist you can align yourself with the client without joining them in the crisis.
-Kristal DeSantis, M.A., LMFT is the founder of Austin STRONG: Relationship Building Center in Austin, TX
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