In the Aftermath: Serial Crisis Intervention for People with HIV
Poindexter, Cynthia Cannon, Health and Social Work
Crisis intervention has been used to assist survivors of assault, families in turmoil, disaster victims, hospital emergency room patients, telephone hot line callers, mental health emergency clients, individuals contemplating suicide, and couples experiencing difficulties. In the 1960s social scientist pioneers such as Caplan (1964), Lindemann (1965), Parad (1965), and Rapoport (1965) developed seminal crisis theory and crisis intervention techniques. Crisis intervention as a theory and intervention model, even though it predates the AIDS epidemic, has much to offer to people with HIV infection because this approach addresses social and health-related trauma. Conversely, listening to people with HIV sheds light on the nature of repeated crises and on useful coping strategies over the trajectory of the illness.
Work with such men and women therefore adds to our understanding of crisis intervention as a method of service delivery. As the number of people with HIV disease continues to increase, there will be an even greater demand for trained social workers who can deliver services effectively, appropriately, and sensitively in crises. This article examines the use of crisis intervention as a treatment modality with people who test positive for HIV or who experience an illness resulting from AIDS - the end stage of HIV infection.
BASIC TENETS OF CRISIS THEORY AND INTERVENTION
Crisis has been defined as a temporary state of disequilibrium during which a person has the potential for heightened maturity and growth or for deterioration and greater vulnerability to future stress. Normal crisis situations are episodic throughout life. Crises are precipitated by specific, meaningful, threatening, identifiable incidents (external or internal, single or cumulative) called "hazardous" events. A state of active crisis exists if customary coping responses are unsuccessful, causing anxiety and uncertainty (Caplan, 1964, 1974; Golan, 1978; Parad, 1965, Rapoport, 1965, 1970).
Crises can be classified as developmental, situational, social, or compound. Developmental crises happen to everyone as people experience transitions or life-cycle changes such as adolescence or old age. Situational crises are caused by nondevelopmental, unexpected, or "out-of-time" traumas and are often specific to the individual or family. Social crises concern larger societal or cultural events or responses, such as discrimination or persecution, and their effect on a particular individual or family. Compound crises occur when a current trauma reactivates responses to previous losses that had receded from consciousness (Golan, 1986; Hoff, 1989; Janosik, 1994).
How a person resolves a crisis state is influenced by the hazardous external circumstances as well as by the person's internal interpretation of events, emotional response, previous experience, personality characteristics, social supports, and the cumulative influence of other recent hazardous events (Aguilera, 1994; Caplan, 1964; Hoff, 1989; Puryear, 1979). People recovering from crises can regain a state of mental health. They do not, however, go back to exactly where they began, because their lives have been substantially and permanently changed (Janoff-Bulman, 1992).
The premises of crisis theory suggest the techniques for mediating trauma. Crisis intervention is a mechanism for delivering the immediate help that a person or family in crisis needs to re-establish equilibrium. It is a time-limited, present-oriented service that focuses on addressing the presenting problem. The basic goals of crisis intervention are psychological resolution of the individual's crisis, practical resolution of aspects of the problem, and restoration to the levels of functioning that existed before the crisis period (Aguilera, 1994; Golan, 1978; Janosik, 1994; Rapoport, 1970). The crisis intervention approach seems best suited to individuals who have experienced a clear-cut hazardous event, have a high level of anxiety or pain, and show evidence of a recent acute breakdown in problem-solving abilities. …