Understanding Crisis Therapies – An Interview with Dr Hilda Loughran

Dr Hilda Loughran is Lecturer in Social Work at University College Dublin, Ireland, and has taught crisis intervention for over 15 years. Her areas of interest include social work education, counselling and research, and drugs and alcohol misuse, including the use of crisis intervention. She has published widely in these areas, and has been engaged in policy and practice research for many years.

Here, Dr Loughran answers some questions about her new book, Understanding Crisis Therapies: An Integrative Approach to Crisis Intervention and Post Traumatic Stress. 

How did you come to work in the field of crisis therapy?

I have been working as a lecturer in University College Dublin for, lets say, some time! In my life before that I worked as a social worker in an alcohol treatment service and also as a marriage counsellor in Dublin. My training was in social work but I got the opportunity to specialise in the addiction field. This was an area that I never wanted to work in…but when the job came up I said I’d give it a try and quickly realised that I loved the work and developed a great respect for the clients. Definitely a lesson about making judgments about something you haven’t even tried. While working in addiction I became interested in brief therapy including motivational interviewing and solution focused work. Somehow the idea that we should think of people as resilient seemed to make a lot of sense. The clients I work with have to make the changes in their own lives and stick with that themselves – I can’t do it for them. This led me back to thinking about crisis intervention, which is in essence the original brief therapy.

Clients live through such difficult experiences and most find strength to keep going. Some can do this with a little help and others might need more sustained help but not all need high level intervention that is intrusive into their lives.

Maybe this is where my own experiences are an influence. I have found that most problems are manageable with the support of family and a network of friends and colleagues. We all have times when it seems that life is tougher than we deserve and we deal with that differently. As a professional I believe it is best to help people deal with these issues in a way that is respectful and supportive and even challenging when necessary and the crisis model certainly fits with these ideas.

What is a crisis event? What are the goals of crisis intervention?

This is a great question because the answer is ‘It depends’. In fact one of the reasons for writing the book is because there is so much misunderstanding about the notion of a crisis event. While of course reading the book will reveal a more complex answer for you, a brief answer would be that it is really impossible to say what constitutes a crisis because it can differ from person to person and from time to time. Some events that are unquestionably very serious and difficult can be handled/responded to in an amazing way and so may appear to ‘not take a thing out’ of someone while other events which do not appear to be challenging can prove to be just too much for someone.

The term crisis actually refers to change and or opportunity, so change is an important aspect of crisis. It may be that the crisis is in some way brought about by not changing or that change actually precipitates the crisis. Whatever the sequence, handling a crisis usually does involve doing something differently – either to cope with the crisis or to change so that the crisis is not repeated. Of course in the book issues around crisis that are precipitated/influenced by more structural or institutional situations are considered and the book really tries to question how some people find themselves dealing with crisis events that they themselves have little control over.

How did the book come about?

The book came about because I began to realise just how complex crisis really is and how our responses to crisis are even more complex. For me there is not one crisis therapy but several therapies that build on the basic ideas that came form the early understanding of crisis.

I was asked to work with a community in Dublin to help them develop skills around crisis intervention. They recognised that their community was essentially experiencing multiple crises often influenced by disadvantage and drug issues. It seemed to me that most work on crisis intervention focused on the individual and helping the individual cope. As someone with an interest in the social sciences I thought that crisis work was underplaying the contribution of the social in thinking about crisis. I put together a course in which students could learn about both the individual and social approaches to understanding crisis and how we as workers/helpers might want to adapt our responses based on a more comprehensive assessment of all aspects that contribute to crisis and to the circumstances that may be important in transforming any event into a crisis. This broad based approach is really helpful in focusing our attention on helping individuals to work toward whatever changes they can make that will be useful, but also in helping them to understand that they may need support from others in that process. The communities that I worked with really took to the crisis intervention course and so this encouraged me to put it down on paper. The students seemed to enjoy exploring questions like your question about what is a crisis and so I have used lots of case examples to help illustrate just how complex crisis can be.

What is timely about the book – are we a more crises-prone society today?

I’d like to think that balancing the individual and social approaches to crisis does offer something special at a time when people may be so burdened by stressful/crisis situations that they may take too much on themselves. This book really emphasises the idea that crises happen in a social context, that social supports can mitigate the devastating effects of a traumatic event and that a lack of social support can make even a simple problem seem insurmountable. I think it was actually George Clooney, in talking about Hurricane Katrina in New Orleans, who commented about the difference between responding to the immediate crisis and continuing to support those trying to put their lives back together. Crisis such as hurricanes, tornados, floods certainly get our attention, and that is good, but we need to also look at underlying social inequalities and disadvantage.

One might also consider the increasing prevalence of Post Traumatic Stress Disorder (PTSD) diagnosis. There is a chapter on PTSD and in it I explore where PTSD fits with ideas about crisis in general. The chapter looks at where ideas about crisis are helpful in understanding PTSD but also suggests that we really need to expand ideas about crisis therapies if we want to address some of the more long-term implications of PTSD. Crisis approaches tend to focus on short-term change, but with PTSD we are now understanding that traumatic events can have longer term consequences. The book explores both PTSD itself and also outlines a developed integrative crisis therapy model which can accomodate the particular needs of PTSD.

How does crisis therapy differ from other interventions with people who have suffered a traumatic experience?

In my view the crisis model is most useful because it recognises the strengths of individuals and also the responsibilities of communities/governments. Crisis therapies are discussed in the plural as opposed to the one type of crisis intervention. The book really explores the idea that there are several forms of crisis therapies and that each is informed by different theories of human activity. What they share in my view are three core ideas: that we have to look to how we can help someone regain a sense of calm in the immediate, and then work toward a confidence about coping and motivation for change ((Loughran 2011, chapter 10). The other important aspect of crisis therapies, however, is that the person is offered the opportunity to identify if they are in crisis and what it is about the event that has triggered the crisis for them. This allows the ‘helper’ to be more sensitive and also targeted about the support they give and the direction they take.

What are the big challenges for professionals in supporting (or in knowing how to support) someone in crisis?

When I work with students, really grasping that crisis is in the mind of the beholder is very difficult. My most helpful advice is to just listen – do not impose your own view or respond to your own fears. What may be a crisis for you may not be for your client. Often we see clients struggling with what seem to be traumatic situations, and sometimes I hear practitioners describing clients as living in a ‘constant state of crisis’. I hope the book will help helpers to question these ideas. The notion of a constant state of crisis is really a contradiction. People in those situations have found a way to live with what’s going on and even though we may think it’s crisis for them it may just have become a way of life; they do not experience the same pressure to change, which is a central component of experiencing crisis. 

It’s also important for professionals to understand that there are many crisis therapies that work with the idea that crisis can facilitate one’s consideration of change. While some view change as a long term process, crisis can if handled appropriately evoke more immediate changes and that with support these changes can be maintained.

For professionals working in the field the most challenging thing can be self care. Working with crisis can be very demanding and in some cases can create a vulnerability in the professional themselves. Self care is essential, and supervision and the opportunity to be reflective form key strategies in keeping yourself in a strong emotional state so that you can actually be helpful.

Copyright © Jessica Kingsley Publishers 2011.